International Journal of Hematology

, Volume 98, Issue 2, pp 264–266 | Cite as

High early death rate in elderly patients with acute promyelocytic leukemia treated with all-trans retinoic acid combined chemotherapy

  • Jun Imagawa
  • Yuka Harada
  • Takeshi Shimomura
  • Hideo Tanaka
  • Yoshiko Okikawa
  • Hironori HaradaEmail author
Letter to the Editor

Dear Editor,

In a recent article in Cancer Science, Ono et al. [1] reported that elderly patients (60–70 years) with acute promyelocytic leukemia (APL) showed a higher induction death rate and non-relapse mortality during consolidation therapy, resulting in a significantly inferior overall survival rate. Many APL clinical trials have found that intensive chemotherapy combined with all-trans retinoic acid (ATRA) dramatically improved patient outcomes. Therefore, it has been generally thought that even elderly APL patients should be treated aggressively to increase the likelihood of curing the disease. However, most clinical trials have excluded elderly patients. Indeed, the German Acute Myeloid Leukemia Cooperative Group showed that 30 % of their newly diagnosed APL patients were age ≥60 years, and of these, 25 % were ineligible for the therapeutic study due to death before therapy, reduced performance status, comorbidity, or concomitant malignancy [2]. Moreover, elderly patients show...


Acute Myeloid Leukemia Acute Promyelocytic Leukemia Arsenic Trioxide Consolidation Therapy Gemtuzumab Ozogamicin 
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Conflict of interest

The authors have no conflict of interest.


  1. 1.
    Ono T, Takeshita A, Kishimoto Y, Kiyoi H, Okada M, Yamauchi T, et al. Long-term outcome and prognostic factors of elderly patients with acute promyelocytic leukemia. Cancer Sci. 2012;103:1974–8.PubMedCrossRefGoogle Scholar
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Copyright information

© The Japanese Society of Hematology 2013

Authors and Affiliations

  • Jun Imagawa
    • 1
  • Yuka Harada
    • 2
    • 6
  • Takeshi Shimomura
    • 3
  • Hideo Tanaka
    • 4
  • Yoshiko Okikawa
    • 5
  • Hironori Harada
    • 1
    • 6
    Email author
  1. 1.Department of Hematology and Oncology, Research Institute for Radiation Biology and MedicineHiroshima UniversityHiroshimaJapan
  2. 2.Division of Radiation Information Registry, Research Institute for Radiation Biology and MedicineHiroshima UniversityHiroshimaJapan
  3. 3.National Hospital Organization Hiroshima-Nishi Medical CenterOhtakeJapan
  4. 4.Hiroshima City Asa HospitalHiroshimaJapan
  5. 5.National Hospital Organization Kure Medical CenterKureJapan
  6. 6.Department of HematologyJuntendo University School of MedicineTokyoJapan

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