Very long-term outcome of acute promyelocytic leukemia after treatment wtih all trans retinoic acid and chemotherapy: the European APL Group experience. - Université de Bourgogne Accéder directement au contenu
Article Dans Une Revue Blood Année : 2009

Very long-term outcome of acute promyelocytic leukemia after treatment wtih all trans retinoic acid and chemotherapy: the European APL Group experience.

Lionel Ades
Agnes Guerci
  • Fonction : Auteur
Miguel Sanz
  • Fonction : Auteur
Patrice Chevallier
Simona Lapusan
  • Fonction : Auteur
Christian Recher
Consuelo Rayon
  • Fonction : Auteur
Sylvie Castaigne
  • Fonction : Auteur
Stephane de Botton
  • Fonction : Auteur
Norbert Ifrah
  • Fonction : Auteur
Jean-Yves Cahn
  • Fonction : Auteur
Eric Solary
Claude Gardin
  • Fonction : Auteur
Augustin Ferrant
  • Fonction : Auteur
Sandrine Meyer-Monard
  • Fonction : Auteur
Norbert Vey
Laurent Degos
  • Fonction : Auteur

Résumé

Acute promyelocytic leukemia (APL) is highly curable with the combination of ATRA and anthracycline based chemotherapy (CT), but very long term results of this treatment, when CT should be added to ATRA and the role of maintenance treatment remain uncertain. In our APL 93 trial that included 576 newly diagnosed APL, with a median follow up of 10 years, 10 year survival was 77%. Maintenance treatment significantly reduced 10 year cumulative incidence of relapses, from 43.2% to 33%, 23.4% and 13.4% with no maintenance, maintenance using intermittent ATRA, continuous 6 mercaptopurine+methotrexate and both treatments, respectively (p<0.0001). Maintenance particularly benefited patients with WBC >5000/ul. Early addition of CT to ATRA significantly improved 10 year EFS, but without significant effect on OS. The 10-year cumulative incidence of deaths in CR, mainly resulting from myelosuppression, was 5.7%, 15.4% and 21.7% in patients aged < 55, 55- 65 years and > 65 years, respectively, supporting the need for less myelosuppressive treatments, particularly for consolidation therapy. This study is registered at http://clinicaltrials.gov as NCT00599937.

Domaines

Immunologie

Dates et versions

hal-00453230 , version 1 (04-02-2010)

Identifiants

Citer

Lionel Ades, Agnes Guerci, Emmanuel Raffoux, Miguel Sanz, Patrice Chevallier, et al.. Very long-term outcome of acute promyelocytic leukemia after treatment wtih all trans retinoic acid and chemotherapy: the European APL Group experience.. Blood, 2009, epub ahead of print. ⟨10.1182/blood-2009-07-233387⟩. ⟨hal-00453230⟩
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