Korean J Intern Med.  2022 Jul;37(4):841-850. 10.3904/kjim.2021.468.

Long-term follow-up results of cytarabine-containing chemotherapy for acute promyelocytic leukemia

• Park YH
• Kim DY
• Mun YC
• Cho EK
• Lee JH
• Jo DY
• Kim I
• Yoon SS
• Park SY
• Kim B
• Bang SM
• Kim H
• Min YJ
• Park JH
• Seo JJ
• Moon HN
• Lee MH
• Kim CS
• Lee WS
• Chong SY
• Oh D
• Zang DY
• Lee KH
• Hyun MS
• Kim HS
• Kim SH
• Kwon H
• Kim HJ
• Park KT
• Bae SH
• Ryoo HM
• Choi JH
• Ahn MJ
• Yoon HJ
• Nam SH
• Kim BS
• Seong CM

• KMID: 2531483
• DOI: http://doi.org/10.3904/kjim.2021.468

Abstract

Background/Aims
We evaluated the feasibility and long-term efficacy of the combination of cytarabine, idarubicin, and all-trans retinoic acid (ATRA) for treating patients with newly diagnosed acute promyelocytic leukemia (APL).
Methods
We included 87 patients with newly diagnosed acute myeloid leukemia and a t(15;17) or promyelocytic leukemia/retinoic acid receptor alpha (PML-RARα) mutation. Patients received 12 mg/m²/day idarubicin intravenously for 3 days and 100 mg/m²/day cytarabine for 7 days, plus 45 mg/m²/day ATRA. Clinical outcomes included complete remission (CR), relapse-free survival (RFS), overall survival (OS), and the secondary malignancy incidence during a 20-year follow-up.
Results
The CR, 10-year RFS, and 10-year OS rates were 89.7%, 94.1%, and 73.8%, respectively, for all patients. The 10-year OS rate was 100% for patients that achieved CR. Subjects were classified according to the white blood cell (WBC) count in peripheral blood at diagnosis (low-risk, WBC < 10,000/mm³; high-risk, WBC ≥ 10,000/mm³). The low-risk group had significantly higher RFS and OS rates than the high-risk group, but the outcomes were not superior to the current standard treatment (arsenic trioxide plus ATRA). Toxicities were similar to those observed with anthracycline plus ATRA, and higher than those observed with arsenic trioxide plus ATRA. The secondary malignancy incidence after APL treatment was 2.7%, among the 75 patients that achieved CR, and 5.0% among the 40 patients that survived more than 5 years after the APL diagnosis.
Conclusions
Adding cytarabine to anthracycline plus ATRA was not inferior to anthracycline plus ATRA alone, but it was not comparable to arsenic trioxide plus ATRA. The probability of secondary malignancy was low.

Keyword

Leukemia; promyelocytic; acute; Cytarabine; Tretinoin; Idarubicin