All-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.

摘要: We entered 26 patients with newly diagnosed acute promyelocytic leukemia (APL) in a pilot study of all-transretinoic acid (ATRA) followed by intensive chemotherapy. Median age was 46 (range 25 to 63). No patient presented leukocytes > 10 x 10(9)/L or had the microgranular APL variant. Cytogenetic analysis (25 patients) found t(15;17) 24 cases. Patients were scheduled receive ATRA (45 mg/m2/d) until complete remission, an daunorubicin (DNR) + Ara C course ("4 7" course), then three "2 5" DNR courses and maintenance chemotheapy. However, "4 administered emergency if hyperleukocytosis rapidly developed prevent leukostasis. Twenty-five (96%) achieved CR, 14 alone 11 after addition on day 2 30 treatment, because increased (9 cases), resistance (1 case), development organomegaly case). The remaining died 6, from CNS bleeding. Apart hyperleukocytosis, side effects usually moderate. In who could be studied vitro, very good correlation between vivo vitro differentiation proliferation blasts ATRA. Three allografted course. Four did not this but received subsequent maintenance. protocol. relapsed 8, 11, 15 months (including one patient). Two 6 17 months. other 20 remained CR 18+ 34+ (median 21). Actuarial disease free interval (DFI) event survival (EFS) 87% 77%, respectively, 18 These results compared those obtained our previous 84 trial chemotherapy (after excluding included hyperleukocytosis). trial, rate 76%, actuarial DFI EFS 59% 48% months, respectively. Differences significant for (P = .02), .006), .08). Although is historical comparison, these suggest that may prove superior APL, slightly increasing rate, perhaps more importantly reducing relapse rate.(ABSTRACT TRUNCATED AT 400 WORDS)