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Annals of Hematology

, Volume 97, Issue 10, pp 1797–1802 | Cite as

Prolonged treatment with arsenic trioxide (ATO) and all-trans-retinoic acid (ATRA) for relapsed acute promyelocytic leukemia previously treated with ATRA and chemotherapy

  • Laura Cicconi
  • Massimo Breccia
  • Luca Franceschini
  • Roberto Latagliata
  • Matteo Molica
  • Mariadomenica Divona
  • Daniela Diverio
  • Manuela Rizzo
  • Tiziana Ottone
  • Licia Iaccarino
  • Valentina Alfonso
  • Robin Foa
  • Maria Teresa Voso
  • Francesco Lo-Coco
Original Article
  • 262 Downloads

Abstract

Prolonged therapy with all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO) is highly effective in newly diagnosed acute promyelocytic leukemia (APL) but there is limited data on the efficacy of this regimen in the relapse setting. We report here on 22 APL patients treated with prolonged ATRA-ATO therapy at the time of disease relapse. Twenty patients obtained molecular complete remission (CRm) after 2 cycles (90%). Of these, two patients underwent hematopoietic stem cell transplant (HSCT) while the remaining proceeded to receive additional cycles (up to a total of 5) of ATRA-ATO. With a median follow-up of 58 months from the time of relapse (range: 21–128 months), the 4-year OS probability was 0.85 (95% CI 0.61–0.94), DFS was 0.74 (95% CI 0.49–0.88), and EFS 0.68 (95% CI 0.45–0.83). Two patients were resistant to ATRA-ATO salvage and five relapsed at a median of 19 months. Of these, four died due to progressive disease while three relapsed achieved a new CRm after further salvage therapy. This experience confirms the potentially curative effect of prolonged ATRA-ATO therapy in relapsed APL, especially in patients with long first complete remission.

Keywords

Acute promyelocytic leukemia ATO ATRA Molecular relapse Stem cell transplant 

Notes

Authors’ contributions

LC, MB, FLC, MM, MD, DD, MR, and MTV collected and analyzed the data; LC, FLC, and MB wrote the paper; MB, LC, and FLC designed the study; TO, VA, LI, DD, and MD collected and analyzed sample and revised the manuscript.

Funding information

This study received financial support from Associazione Italiana Ricerca sul Cancro (AIRC, IG N. 5916 to FLC and fellowship 19738 LC) and from Associazione italiana contro le Leucemie-Linfomi e Mieloma (AIL).

Compliance with ethical standards

Conflict of interest

LC received honorary for speaker’s bureau from TEVA; FLC and MB received honorary for speaker’s bureau and advisory board from TEVA.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Laura Cicconi
    • 1
  • Massimo Breccia
    • 2
  • Luca Franceschini
    • 1
  • Roberto Latagliata
    • 2
  • Matteo Molica
    • 2
  • Mariadomenica Divona
    • 3
  • Daniela Diverio
    • 2
  • Manuela Rizzo
    • 3
  • Tiziana Ottone
    • 1
  • Licia Iaccarino
    • 1
  • Valentina Alfonso
    • 1
  • Robin Foa
    • 2
  • Maria Teresa Voso
    • 1
  • Francesco Lo-Coco
    • 1
  1. 1.Department of Biomedicine and PreventionUniversity Tor VergataRomeItaly
  2. 2.Department of Cellular Biotechnologies and HematologySapienza UniversityRomeItaly
  3. 3.Policlinico Tor VergataRomeItaly

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