Incidence, risk factors, and outcomes of second neoplasms in patients with acute promyelocytic leukemia: the PETHEMA-PALG experience

• DOI: 10.1007/s00277-023-05582-y
• Publication Date: 2023-12-19T03:02:16Z
• Authors: Marta Sobas; Wanda Knopinska-P...; Beata Piątkowska-...; Flor García-Álvarez; María Elena Amuti...; Mar Caballero; David Martínez-Cu...; Eliana Aguiar; Jose González-Campos; Ana Garrido; Lorenzo Algarra; Olga Salamero; Javier de la Serna; Maria Jose Sayas; Manuel Mateo Pere...; Susana Vives; Belén Vidriales; Jorge Labrador; Ana Inés Prado; Lucía Celebrin; Jiri Mayer; Joana Brioso; Almudena de Laigl...; Juan Miguel Bergua; Maria Luz Amigo; Carlos Rodriguez-...; Marta Polo; Agnieszka Pluta; Edyta Cichocka; Marek Skarupski; Miguel A Sanz; Agnieszka Wierzbo...; Pau Montesinos
• Keywords: Adult; Otros calificadores::Otros calificadores::Otros calificadores::/farmacoterapia; Tretinoin; Outcomes; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk Factors; outcomes; SDG 3 – Goede gezondheid en welzijn; DISEASES::Neoplasms::Neoplasms by Histologic Type::Leukemia::Leukemia, Myeloid::Leukemia, Myeloid, Acute::Leukemia, Promyelocytic, Acute; SDG 3 - Good Health and Well-being; Leukemia, Promyelocytic, Acute; Acute promyelocytic leukemia; Risk Factors; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::técnicas de investigación::métodos epidemiológicos::estadística como asunto::probabilidad::riesgo::factores de riesgo; Antineoplastic Combined Chemotherapy Protocols; risk factors; Humans; Second neoplasms; Retrospective Studies; Other subheadings::Other subheadings::Other subheadings::/drug therapy; ENFERMEDADES::neoplasias::neoplasias por tipo histológico::leucemia::leucemia mieloide::leucemia mieloide aguda::leucemia promielocítica aguda; second neoplasms; Incidence; chemotherapy based and chemotherapy free regimens; Neoplasms, Second Primary; acute promyelocytic leukemia; Chemotherapy based and chemotherapy free regimens; Treatment Outcome; Risk factors; Leucèmia mieloide aguda - Tractament; Pathologic Complete Response; Original Article; Leucèmia mieloide aguda - Factors de risc

AbstractThe most important challenges in acute promyelocytic leukemia (APL) is preventing early death and reducing long-term events, such as second neoplasms (s-NPLs). We performed a retrospective analysis of 2670 unselected APL patients, treated with PETHEMA “chemotherapy based” and “chemotherapy free” protocols. Only de novo APL patients who achieved complete remission (CR) and completed the three consolidation cycles were enrolled into the analysis. Out of 2670 APL patients, there were 118 (4.4%) who developed s-NPLs with the median latency period (between first CR and diagnosis of s-NPL) of 48.0 months (range 2.8–231.1): 43.3 (range: 2.8–113.9) for s-MDS/AML and 61.7 (range: 7.1–231.1) for solid tumour. The 5-year CI of all s-NPLs was of 4.43% and 10 years of 7.92%. Among s-NPLs, there were 58 cases of s-MDS/AML, 3 cases of other hematological neoplasms, 57 solid tumours and 1 non-identified neoplasm. The most frequent solid tumour was colorectal, lung and breast cancer. Overall, the 2-year OS from diagnosis of s-NPLs was 40.6%, with a median OS of 11.1 months. Multivariate analysis identified age of 35 years (hazard ratio = 0.2584;p< 0.0001) as an independent prognostic factor for s-NPLs. There were no significant differences in CI of s-NPLs at 5 years between chemotherapy-based vs chemotherapy-free regimens (hazard ratio = 1.09;p= 0.932). Larger series with longer follow-up are required to confirm the potential impact of ATO+ATRA regimens to reduce the incidence of s-NPLs after front-line therapy for APL.