Analysis of prognostic factors in newly diagnosed acute promyelocytic leukemia treated with all-trans retinoic acid and chemotherapy. Japan Adult Leukemia Study Group.

• DOI: 10.1200/jco.1998.16.1.78
• Publication Date: 2017-02-24T10:06:55Z
• Authors: N Asou; K Adachi; J Tamura; A Kanamaru; S Kageyama; A Hiraoka; E Omoto; H Akiyama; K Tsubaki; K Saito; K Kuriyama; H Oh; K Kitano; S Miyawaki; K Takeyama; O Yamada; K Nishikawa; M Takahashi; S Matsuda; S Ohtake; H Suzushima; N Emi; R Ohno
• Keywords: Adult; Aged, 80 and over; Male; Analysis of Variance; Adolescent; Daunorubicin; Age Factors; Cytarabine; Tretinoin; Middle Aged; Prognosis; 3. Good health; Leukocyte Count; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Leukemia, Promyelocytic, Acute; Antineoplastic Combined Chemotherapy Protocols; Humans; Female; Prospective Studies; Aged; Bone Marrow Transplantation

PURPOSE We conducted a multicenter study of differentiation therapy with all-trans retinoic acid (ATRA) followed by intensive chemotherapy in patients with newly diagnosed acute promyelocytic leukemia (APL) and analyzed the prognostic factors for predicting complete remission (CR), event-free survival (EFS), and disease-free survival (DFS). PATIENTS AND METHODS All patients received ATRA until CR. If patients had an initial leukocyte count greater than 3.0 x 10(9)/L, they received daunorubicin (DNR) and behenoyl cytarabine (BHAC). During therapy, if patients showed blast and promyelocyte counts greater than 1.0 x 10(9)/L, they received additional DNR and BHAC. After achieving CR, patients received three courses of consolidation and six courses of maintenance/intensification chemotherapy. RESULTS Of 198 registered, 196 were assessable (age range, 15 to 86 years; median, 46) and 173 (88%) achieved CR. Multivariate analysis showed that no or minor purpura at diagnosis (P = .0046) and age less than 30 years (P = .0076) were favorable factors for achievement of CR. Predicted 4-year overall survival and EFS rates were 74% and 54%, respectively, and the 4-year predicted DFS rate for 173 CR patients was 62%. Multivariate analysis showed that age less than 30 years (P = .0003) and initial leukocyte count less than 10 x 10(9)/L (P = .0296) were prognostic factors for longer EFS, and initial leukocyte count less than 10.0 x 10(9)/L was a sole significant prognostic factor for longer DFS (P = .0001). CONCLUSION Our results show that age, hemorrhagic diathesis, and initial leukocyte count are prognostic factors for APL treated with ATRA followed by intensive chemotherapy.