Abstract
Between February 1992 and November 1996 we treated 30 newly diagnosed acute promyelocytic leukaemia (APL) patients either with oral all-trans-retinoic acid (ATRA) alone (45 mg m-2) or with a simultaneous combination of ATRA (45 mg m-2), daunorubicin (DNR, 50 mg/m-2 for 3 days) and cytosine arabinoside (ARA-C, 200 mg m-2 for 7 days). There were 15 patients in each group. Patients with a white blood cell count < 5 x 109/l at diagnosis received only ATRA as an induction therapy. Patients with initial white blood cell count > 5 x 109/l received a combination of ATRA, DNR and ARA-C as an induction therapy. Within the first 20 days of induction, there were two early deaths in the group of patients receiving only ATRA, and six early deaths in the group of patients treated with a combination of ATRA and chemotherapy. Ten out of 13 patients (76.9%) receiving ATRA only achieved complete remission (CR) whereas seven out of nine patients (77.8%) receiving ATRA with chemotherapy achieved CR. Initial median peripheral white blood cell counts were significantly lower in the group of patients treated with ATRA alone (2.3 x 109/l) than in the group of patients receiving ATRA and chemotherapy (14.0 x 109/l). Morphological evidence of differentiation was noted in all patients entering CR. Patients in both groups who achieved CR received one course of standard ′3+7′ chemotherapy (DNR 45 mg m-2,1 -3 days, ARA-C 200 mg m-2,1-7 days) followed by two courses of standard ′2+5′ chemotherapy (DNR 50 mg m-2 1-2 days, ARA-C 200 mg m-2 1-5 days) as a consolidation therapy. Patients not achieving remission (three out of 13 in the ATRA group and two out of nine in ATRA+chemotherapy group) did not respond to salvage chemotherapy and all died within 3 months of diagnosis. Only one out of 10 patients (10%) in CR, treated with ATRA is in relapse after 18 months. In patients treated with ATRA alone two out of 10 (20%) survived 58 months following diagnosis whereas in the ATRA+chemotherapy group one out of seven has already survived their 58th month since diagnosis. Four out of eight patients with an early death died of retinoic acid syndrome. Other toxicities due to ATRA were minimal (cheilitis, xerosis, dermatitis, diarrhoea, liver damage or pseudotumor cerebri).
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Bennett, J.M., Catovsky, D., Daniel, M.T., Flandrin, G., Galton, D.A.G., Gralnick, M. and Sultan, C. (1976) Proposals for the classification of the acute leukemias.British Journal of Haematology 33, 451–458.
Larson, R.A., Kondo, K., Vardiman, J.W., Butler, A.R.E., Golomb, H.M. and Rowley, J.D. (1984) Evidence for a 15;17 translocation in every patient with acute promyelocytic leukemia.American Journal of Medicine 76, 827–841.
Drapkin, R.L., Gee, R.S., Dowling, M.D., Arlin, Z., McKenzie, S., Kempin, S. and Clarkson, B. (1978) Prophylactic heparin therapy in acute promyelocytic leukemia.Cancer 41, 2484–2490.
Huang, M., Ye, Y., Chen, S., Chai, J., Lu, J., Zhoa, L., Gu, L. and Wang, Z. (1988) Use of all-trans-retinoic acid in the treatment of acute promyelocytic leukemia.Blood 72, 567–572.
Cunningham, I., Gee, T., Reich, L., Kempin, S., Naval, A. and Clarkson, B. (1989) Acute promyelocytic leukemia: Treatment results during a decade at Memorial Hospital.Blood 73, 1116–1122.
Čolović, M.D., Janković, G.M. and Petrović, M.D. (1990) Long term survival in acute leukemia in adults.British Journal of Haematology 76, 560–563.
Degos, L., Chomienne, C., Daniel, M.T., Berger, R., Dombret, H., Fenaux, P. and Castaigne, S. (1990) Treatment of first relapse in acute promyelocytic leukemia with all-trans-retinoic acid.Lancet 11, 1440–1941.
Castaigne, S., Chomienne, C., Daniel, M.T., Ballerini, P., Berger, R., Fenaux, P. and Degos, L. (1990).All-trans- retinoic acid as a differentiation therapy for acute promyelocytic leukemia. I. Clinical results.Blood 76, 1704–1709.
Chomienne, C., Ballerini, P., Balitrand, N., Daniel, M.T., Fenaux, P., Castaigne, S. and Degos, L. (1990).All-trans- retinoic acid in promyelocytic leukemias. II.In vitro studies structure relationship function.Blood 76, 1710–1717.
Warrell, R.P., Frankel, S.R., Miller, W.H., Scheinberg, DA., Itri, L.M., Hittelman, W.N., Vyas, R., Andreeff, M., Tafuri, A., Jakubowski, A., Gabrilove, J., Gordon, M.S. and Dmitrowsky E. (1991) Differentiation therapy in acute promyelocytic leukemia with tretinoin (all-trans-retinoic acid).New England Journal of Medicine 324, 1385–1393.
Chen, Z.X., Xue, Y.O., Zhang, R., Tao, R.F., Xia, X.M., Li, C., Wang, W., Zu, W.Y., Yao, X.Z. and Limg, B.L. (1991) A clinical and experimental study on all-trans-retinoic acid treated acute promyelocytic leukemia patients.Blood 78, 1413–1419.
Ohno, R., Naoe, T. and Yoshida, H. (1992) Acute promyelocytic leukemia and differentiation therapy.Naika 69, 1359–1362.
Novak, A., Kruškić, M., Ludoški, M. and Jurukovski, V. (1994) Rapid method for obtaining high quality chromosome banding in the study of hemopoetic neoplasia.Cancer Genetic and Cytogenetic 74, 109–114.
Kaplan, E. and Meier, P. (1958) Nonparametric estimation from incomplete observations.American Statistical Association Journal 53, 457–1958.
Bernard, J., Weil, M., Boiron, M., Jacquillat, C., Flaudrin, G. and Gemon, F. (1973) Acute promyelocytic leukemia. Results of treatment with daunirubidn.Blood 41, 489–496.
Kantarjian, H., Keating, M. and Walters, R. (1986) Acute promyelocytic leukemia. MD Anderson Hospital experience.American Journal of Medicine 80, 789–797.
Cordonnier, C., Vernant, J.P., Brun, B., Knentz, M., Jouault, M., Mannoni, P., Dreyfus, B. and Rochaut, M. (1985) Acute promyelocytic leukemia in 57 previously untreated patients.Cancer 55, 18–25.
Feuaux, P., Tertian, G., Castaique, S., Tilly, M., Leverger, G., Bauters, F. and Marty, M. (1991) A randomized trial of amsacrine and rubidazone in 39 patients with acute promyelocytic leukemia.Journal of Clinical Oncology 9, 1556–1561.
Hoyle, C., Swirsky, D., Freedman, L. and Hayhol, F.G.J. (1988) Beneficial effect of heparin in the management of patients with APL.British Journal of Haematology 68, 283–289.
Stone, R.M., Magnire, M., Goldberg, M.A., Antin, J.N., Rosenthal, D.S. and Mayer, R.J. (1988) Complete remission in acute promyelocytic leukemia despite persistence of abnormal bone marrow promyelocytes during induction therapy. Experience in 34 patients.Blood 71, 690–696.
Ohno, R., Yoshida, H., Fukutani, H., Naoe, T., Ohshima, T., Kyo, T., Endoh, N., Fujimoto, T., Kobayashi, T., Hiraoka, A., Mizoquchi, H., Kodera, Y., Suzuki, H., Hirano, M., Akiyama, H., Aoki, N., Shindo, H., Yokomaky, S. and the Leukemia Study Group of the Ministry of Health and Welfare. (1993) Multi-institutional study of all-trans-retinoic acid as a differentiation therapy of refractory acute promyelocytic leukemia.Leukemia 1722–1727.
Hiddemann, W., Martin, W.R., Sanerland, CM., Heinecke, A. and Buchner, T. (1990) Definition of refractoriness against conventional chemotherapy in acute myeloid leukemia: a proposal based upon the results of retreatment by thioguanine cytosine arabinoside and duanoblastin (TAD 9) in 150 patients with relapse after standardized first line therapy.Leukemia 4, 184–188.
Fenaux, P., Le Deley, M.C., Castaigne, S., Archimbaud, E., Chomienne, C., Link, H., Guerci, A., Duarte, M., Daniel, M.T., Bowen, D., Huebner, G., Bauters, F., Fegueux, N., Fey, M., Sanz, M., Lowenberg, B., Maloisel, F., Auzanneau, G., Sadoun, A., Gardin, C., Bastion, Y., Ganser, A., Jacky, E., Dombret, H., Chastang, C., Degos, L. and the European APL 91 group. (1993) Effect of All transretinoic acid in newly diagnosed acute promyelocytic leukemia. Results of multicenter randomized trial.Blood 82, 3241–3249.
Fenaux, P., Castaigne, S., Dombert, H., Archimbaud, E., Duarte, M., Morel, P., Lamy, T., Guerci, A., Maloissel, F., Bordenoule, D., Sadoun, A., Tiberhien, P., Feguex, N., Daniel, M.T., Chomienne, C. and Defos, L. (1992) AU transretinoic acid followed by intensive chemotherapy gives a high complete remission rate and may prolong remissions in newly diagnosed acute promyelocytic leukemia: A pilot study on 26 cases.Blood 80, 2176.
Frankel, S.R., Fardley, A., Lanwers, G., Wiss, M. and Warrell, R. (1992) The ‘retinoic acid syndrome’ in acute promyelocytic leukemia.Annals of Internal Medicine 117, 292–296.
Douer, D. and Koeffler, H. (1982) Retinoic acid enhances colony stimulating factor-induced clonal growth of normal human lyeloid progenitor cellsin vitro.Experimental Cell Research 138,193–198.
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Čolović, M.D., Janković, G.M., Elezović, I. et al. Effect of all-trans-retinoic acid alone or in combination with chemotherapy in newly diagnosed acute promyelocytic leukaemia. Med Oncol 14, 65–72 (1997). https://doi.org/10.1007/BF02990950
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DOI: https://doi.org/10.1007/BF02990950