Safety and efficacy of arsenic trioxide and all-trans retinoic acid therapy in acute promyelocytic leukemia patients with a high risk for early death.
In this study, we investigated the safety and efficacy of arsenic trioxide (ATO) and all-trans retinoic acid (ATRA) in patients with acute promyelocytic leukemia (APL). The patients had been classified as unfit to receive anthracycline-based chemotherapy due to high-risk factors for early death. Twenty-five patients with APL receiving ATO/ATRA between 2007 and 2018 were divided into 3 groups as follows: elderly patients (age ≥ 70 years) with poor performance status (32%); patients with severe active infections at diagnosis (56%); and patients with multiple significant comorbidities (24%) who were unfit for conventional chemotherapy, regardless of age. Induction therapy comprised 0.15 mg/kg/day ATO combined with 45 mg/m2/day ATRA until patients attained complete remission (CR). Notably, only one patient (4.0%) died of septic shock 2 days after the ATO treatment had been initiated. The remaining 24 patients attained CR despite their serious and desperate conditions at diagnosis. In total, 44%, 28%, and 32% of the patients experienced neutropenia (grade 3 or 4), thrombocytopenia, and hepatopathy, respectively. Twenty-three of the 24 patients in CR proceeded to consolidation therapy and attained complete molecular remission with favorable overall survival (90.7%). This study demonstrates the safety and efficacy profile of ATO/ATRA first-line therapy for patients with APL and high-risk features for early death.
['Min|Gi-June|GJ|', 'Cho|Byung-Sik|BS|', 'Park|Sung-Soo|SS|', 'Park|Silvia|S|', 'Jeon|Young-Woo|YW|', 'Yahng|Seung-Ah|SA|', 'Shin|Seung-Hawn|SH|', 'Yoon|Jae-Ho|JH|', 'Lee|Sung-Eun|SE|', 'Eom|Ki-Seong|KS|', 'Kim|Yoo-Jin|YJ|', 'Lee|Seok|S|', 'Min|Chang-Ki|CK|', 'Cho|Seok-Goo|SG|', 'Kim|Dong-Wook|DW|', 'Lee|Jong Wook|JW|', 'Kim|Hee-Je|HJ|']
D000328:Adult D000368:Aged D000971:Antineoplastic Combined Chemotherapy Protocols D000077237:Arsenic Trioxide D018572:Disease-Free Survival D005260:Female D006801:Humans D015473:Leukemia, Promyelocytic, Acute D008297:Male D008875:Middle Aged D012189:Retrospective Studies D012307:Risk Factors D015996:Survival Rate D014212:Tretinoin
Arsenic trioxide Acute promyelocytic leukemia Early death