All-trans retinoic acid therapy for newly diagnosed acute promyelocytic leukemia: comparison with intensive chemotherapy

被引：0

作者：

N. Asou

Koichi Adachi

Jun-ichi Tamura

Akihisa Kanamaru

Shin-ichi Kageyama

Akira Hiraoka

Eijiro Omoto

Hisashi Sakamaki

Kazuo Tsubaki

Kenji Saito

Ryuzo Ohno

机构：

[1] Second Department of Internal Medicine,

[2] Kumamoto University School of Medicine,undefined

[3] 1-1-1 Honjo,undefined

[4] Kumamoto 860,undefined

[5] Japan Tel. 81 96 373 5156; Fax +8196 363 5265,undefined

[6] First Department of Internal Medicine,undefined

[7] Nagoya University School of Medicine,undefined

[8] Nagoya,undefined

[9] Japan,undefined

[10] Third Department of Internal Medicine,undefined

[11] Gunma University School of Medicine,undefined

[12] Maebashi,undefined

[13] Japan,undefined

[14] Second Department of Internal Medicine,undefined

[15] Hyogo College of Medicine,undefined

[16] Nishinomiya,undefined

[17] Japan,undefined

[18] Second Department of Internal Medicine,undefined

[19] Mie University School of Medicine,undefined

[20] Tsu,undefined

[21] Japan,undefined

[22] Fifth Department of Internal Medicine,undefined

[23] Center for Adult Diseases,undefined

[24] Osaka,undefined

[25] Japan,undefined

[26] Second Department of Internal Medicine,undefined

[27] Okayama University School of Medicine,undefined

[28] Okayama,undefined

[29] Japan,undefined

[30] Department of Internal Medicine,undefined

[31] Tokyo Metropolitan Komagome Hospital,undefined

[32] Tokyo,undefined

[33] Japan,undefined

[34] Third Department of Internal Medicine,undefined

[35] Kinki University School of Medicine,undefined

[36] Osaka,undefined

[37] Japan,undefined

[38] Third Department of Internal Medicine,undefined

[39] Dokkyo University School of Medicine,undefined

[40] Tochigi,undefined

[41] Japan,undefined

[42] Third Department of Internal Medicine,undefined

[43] Hamamatsu Medical School,undefined

[44] Hamamatsu,undefined

[45] Japan,undefined

来源：

Cancer Chemotherapy and Pharmacology | 1997年 / 40卷

关键词：

Key words Acute promyelocytic leukemia; All-trans retinoic acid; Differentiation therapy; Chemotherapy;

D O I：

暂无

中图分类号：

学科分类号：

摘要：

We analyzed the results of treating patients with newly diagnosed acute promyelocytic leukemia (APL) with all-trans retinoic acid (ATRA) in the JALSG AML-92 study and compared them with those of the AML-87 and AML-89 studies, which consisted of standard chemotherapy. In the AML-92 study, patients were scheduled to receive 45 mg/m2 oral ATRA daily until achievement of a complete remission (CR). If patients had initial leukocyte counts of >3.0×109/l, they received 40 mg/m2 daunorubicin (DNR) for 3 days and 200 mg/m2 behenoyl cytarabine (BHAC) for 5 days in addition to ATRA. During remission induction therapy, if the patients showed peripheral blood myeloblast and promyelocyte counts of >1.0×109/l, they received additional DNR and BHAC on the same schedule. After achievement of a CR, patients received three courses of consolidation and six courses of maintenance/intensification chemotherapy. Of 196 evaluable patients, 173 (88%) achieved a CR: 59 of 62 (95%) treated with ATRA alone, 41 of 49 (84%) treated with ATRA plus later chemotherapy, 63 of 73 (86%) treated with ATRA plus initial chemotherapy, and 10 of 12 (83%) treated with ATRA plus both initial and later chemotherapy. The CR rate in AML-92 was significantly higher than that in AML-89, but not than that achieved in AML-87. In addition, the early mortality and relapse rates in AML-92 were significantly lower than those in AML-89, but were not than those in AML-87. At a median follow-up of 36 months the predicted 4-year event-free survival (EFS) rate for 196 evaluable patients and the 4-year disease-free survival (DFS) rate for the CR cases were 54% and 62%, respectively. There was a significant difference in DFS between AML-92 and AML-87 (P = 0.0418) but not between AML-92 and AML-89 (P = 0.0687). In contrast, significant differences in EFS between AML-92 and both AML-87 (P = 0.0129) and AML-89 (P = 0.005) were observed. These results suggest that non-cross-resistant therapy combined with ATRA and intensive chemotherapy for APL contributes synergistically to the significant improvement in EFS.

引用

页码：S30 / S35