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Flow Cytometry to Estimate Leukemia Stem Cells in Primary Acute Myeloid Leukemia and in Patient-derived-xenografts, at Diagnosis and Follow Up

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Second Primary Malignancy after Acute Promyelocytic Leukemia: A Population-Based Study.

Luana Lenzi^1,2,3, Lisa Lee-Jones², Maruf A Mostofa²

¹Departamento de Análises Clínicas, Universidade Federal do Paraná, Curitiba, Paraná 80210-170, Brazil.

|December 8, 2020

Summary

Acute promyelocytic leukemia (APL) patients treated with all-trans retinoic acid (ATRA) may have an increased risk of second primary malignancies (SPMs). Non-Hispanic white ethnicity and older age at APL diagnosis are also associated with SPM development.

Keywords:

APL ATRA acute promyelocytic chemotherapy leukemia

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Area of Science:

Hematology
Oncology
Cancer Epidemiology

Background:

Acute promyelocytic leukemia (APL) is a highly curable leukemia, often treated with all-trans retinoic acid (ATRA).
Limited data exists on the incidence and risk factors for second primary malignancies (SPMs) in APL survivors.
Genetic variations in Hispanic populations may influence APL incidence, but SPM associations are less understood.

Purpose of the Study:

To investigate the association between ethnicity, all-trans retinoic acid (ATRA) treatment, and the rate of second primary malignancies (SPMs) in patients with acute promyelocytic leukemia (APL).
To identify risk factors for SPM development in APL survivors.
To compare the types of SPMs in APL patients versus non-APL malignancies.

Main Methods:

Utilized the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2016.
Analyzed 4019 patients with APL, identifying 116 cases of SPM.
Compared SPM incidence and risk factors between APL survivors and a control group of APL survivors without SPMs, and between APL patients and non-APL AML patients.

Main Results:

Age ≥40 years at APL diagnosis and non-Hispanic white ethnicity were significantly associated with increased SPM risk (p < 0.001 and p = 0.025, respectively).
SPMs were more common in APL patients compared to individuals with non-APL malignancies, with salivary gland, liver, and soft tissue cancers being more frequent.
Risk analysis suggested an association between ATRA treatment and SPMs in APL survivors.

Conclusions:

Age and ethnicity are significant factors influencing SPM development in APL survivors.
All-trans retinoic acid (ATRA) treatment may be associated with an increased risk of SPMs after APL.
Enhanced surveillance and early diagnosis of SPMs are crucial for patients with a history of APL.