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Arsenic trioxide-based therapy of relapsed acute promyelocytic leukemia: registry results from the European
E Lengfelder1, F Lo-Coco2, L Ades3
1Department of Hematology and Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany.
Abstract:
In 2008, a European registry of relapsed acute promyelocytic leukemia was established by the European LeukemiaNet. Outcome data were available for 155 patients treated with arsenic trioxide in first relapse. In hematological relapse (n=104), 91% of the patients entered complete hematological remission (CR), 7% had induction death and 2% resistance, 27% developed differentiation syndrome and 39% leukocytosis, whereas no death or side effects occurred in patients treated in molecular relapse (n=40). The rate of molecular (m)CR was 74% in hematological and 62% in molecular relapse (P=0.3). All patients with extramedullary relapse (n=11) entered clinical and mCR. After 3.2 years median follow-up, the 3-year overall survival (OS) and cumulative incidence of second relapse were 68% and 41% in hematological relapse, 66% and 48% in molecular relapse and 90 and 11% in extramedullary relapse, respectively. After allogeneic or autologous transplantation in second CR (n=93), the 3-year OS was 80% compared with 59% without transplantation (n=55) (P=0.03). Multivariable analysis demonstrated the favorable prognostic impact of first remission duration ⩾1.5 years, achievement of mCR and allogeneic or autologous transplantation on OS of patients alive after induction (P=0.03, P=0.01, P=0.01) and on leukemia-free survival (P=0.006, P<0.0001, P=0.003), respectively.
Insights
Arsenic trioxide effectively treats relapsed acute promyelocytic leukemia, achieving high remission rates. Transplantation significantly improves overall survival in patients achieving complete remission.
Area of Science:
- Hematology
- Oncology
- Clinical Trials
Background:
- Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia.
- Relapse remains a challenge in APL management, necessitating effective salvage therapies.
- Arsenic trioxide has emerged as a crucial agent in APL treatment.
Purpose of the Study:
- To evaluate the efficacy and outcomes of arsenic trioxide in patients with relapsed acute promyelocytic leukemia.
- To compare outcomes across different types of relapse (hematological, molecular, extramedullary).
- To assess the impact of consolidation therapy, specifically transplantation, on survival.
Main Methods:
- Retrospective analysis of data from a European registry of relapsed APL patients treated with arsenic trioxide.
- Inclusion of 155 patients experiencing first relapse.
- Follow-up for overall survival and cumulative incidence of second relapse.
Main Results:
- High complete hematological remission (CR) rates (91%) in hematological relapse, with lower rates of molecular CR (74%).
- No deaths or significant side effects observed in molecular relapse patients.
- 3-year overall survival (OS) was 68% for hematological relapse and 66% for molecular relapse.
- Allogeneic or autologous transplantation in second CR significantly improved 3-year OS (80% vs. 59%).
Conclusions:
- Arsenic trioxide is an effective salvage therapy for relapsed APL, particularly in molecular relapse.
- Achievement of molecular CR and subsequent transplantation are critical for long-term survival.
- First remission duration and consolidation with transplantation are favorable prognostic factors for OS and leukemia-free survival.
