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Posted by on Jul 11, 2020 in Leukemia | 0 comments

In a nutshell

This study aimed to investigate the safety and effectiveness of the combination of all-trans-retinoic acid (Vesanoid), arsenic trioxide (Trisenox), and idarubicin (Idamycin) as front-line treatment for acute promyelocytic leukemia. 

This study concluded that this combination is safe and effective for these patients.  

Some background

Acute promyelocytic leukemia (APL) is an aggressive type of acute myeloid leukemia (AML). All-trans-retinoic acid (ATRA) and arsenic trioxide (ATO) are used in the treatment of APL. Idarubicin (IDA) is a chemotherapy drug. 

Induction treatment is given to induce remission. Consolidation treatment aims to destroy any remaining cells and prevent relapse. It was unknown if a combination of ATRA, ATO, and IDA would be safe and effective as induction and consolidation treatment in patients with APL.  

Methods & findings

This study involved 118 patients with APL. Patients were classified as either high-risk (HR) or standard-risk (SR) APL. Patients were treated with ARTA, ATO, and IDA as induction treatment and consolidation treatment. The average follow-up was 1813 days (approximately 5 years). 

97.5% of patients had hematologic complete remissions (complete disappearance of cancer signs in the blood). 88.7% of patients achieved molecular complete remission (complete disappearance of leukemia cells in the bone marrow) following induction treatment. 

The 5-year overall survival (OS) rate was 93%. The 5-year event-free survival (EFS; survive without complication from the APL) was 92.4%. The OS rate for the SR group was 92.3% compared to 92.8% for the HR group. The EFS rate for the SR group was 92.3% compared to 91.1% for the HR group.  

Early death, hematologic complete remissions, molecular complete remissions, and side effects were similar between the HR and SR patients. The 5-year OS rate was 92.3% for SR patients and 92.8% for HR patients. The 5-year EFS rate was 92.3% for SR patients and 91.1% for HR patients.

The overall occurrence of relapse was 4.7% in the HR group compared to 0% in the SR group. None of the patients experienced heart side effects related to treatment. 

The bottom line

This study concluded that the triple combination of ATRA, ATO, and IDA is safe and effective as induction and consolidation treatments for HR and SR APL patients. The authors suggested that this treatment may be a preferred frontline treatment for patients with HR-APL or APL with abnormal genes.  

The fine print

This study was based on medical records. Information might have been incomplete. Further controlled studies are needed.

Published By :

Clinical lymphoma, myeloma & leukemia

Date :

Jul 01, 2020

Original Title :

Improved Outcomes of All-trans-retinoic Acid and Arsenic Trioxide Plus Idarubicin as a Frontline Treatment in Adult Patients With Acute Promyelocytic Leukemia.

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