Treatment of acute promyelocytic leukemia with all-trans retinoic acid. A five-year experience.
From January 1986 to April 1991, 107 consecutive patients with acute promyelocytic leukemia (APL) were treated with retinoic acid (RA) at an oral dose of 45-60mg/m2/d, alone or in combination with chemotherapy. In 91 cases treated with RA alone, 74 (81.3%) achieved complete remission (CR). The CR rate was 75% in 16 cases treated with combined therapy. Among 50 patients closely followed for a median of 36 months (4-60), 10 received RA as continuation therapy (Group A), 10 received chemotherapy (Group B) and 30 were treated with RA and chemotherapy alternately in regular sequence (Group C). The mean survival time was 8.4, 9.7 and 21.6 months, respectively, for the 29 cases who died. The survival probability was higher in Group C than in Group A and B (P < 0.01). RA did not provoke or aggravate DIC, it did not cause marrow hypoplasia or aplasia. The side effects were relatively mild as compared with chemotherapy. CFU-GM markedly reduced before treatment was restored to normal level after CR, while the result for L-CFU was reversed. In 40 cases examined for in vitro induction of differentiation, 39 responders were culminating in CR. Aberrant karyotype t (15; 17) was positive in all 47 cases examined prior to the treatment. It disappeared in all of the 20 cases studied after achieving CR, and reappeared in 3 cases following relapse. The best regimen to maintain a longer CR duration and survival time in this study was to use RA and chemotherapy alternately as continuation therapy.
Sun
G L
GL
Shanghai Institute of Hematology, Shanghai Second Medical University.
Ouyang
R R
RR
Chen
S J
SJ
Gu
Y Z
YZ
Huang
L A
LA
Lu
J X
JX
Wang
Z Y
ZY
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003561:Cytarabine / Q000008:administration & dosage; D005260:Female; D006248:Harringtonines / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D012074:Remission Induction; D014212:Tretinoin / Q000627:therapeutic use*; D014750:Vincristine / Q000008:administration & dosage
D006248:Harringtonines; D003561:Cytarabine; D014212:Tretinoin; D014750:Vincristine; D011241:Prednisone