title: Analysis of prognostic factors in newly diagnosed acute promyelocytic leukemia treated with all-trans retinoic acid and chemotherapy. Japan Adult Leukemia Study Group.
abstract: OBJECTIVE
  We conducted a multicenter study of differentiation therapy with all-trans retinoic acid (ATRA) followed by intensive chemotherapy in patients with newly diagnosed acute promyelocytic leukemia (APL) and analyzed the prognostic factors for predicting complete remission (CR), event-free survival (EFS), and disease-free survival (DFS).
  
  
  METHODS
  All patients received ATRA until CR. If patients had an initial leukocyte count greater than 3.0 x 10(9)/L, they received daunorubicin (DNR) and behenoyl cytarabine (BHAC). During therapy, if patients showed blast and promyelocyte counts greater than 1.0 x 10(9)/L, they received additional DNR and BHAC. After achieving CR, patients received three courses of consolidation and six courses of maintenance/intensification chemotherapy.
  
  
  RESULTS
  Of 198 registered, 196 were assessable (age range, 15 to 86 years; median, 46) and 173 (88%) achieved CR. Multivariate analysis showed that no or minor purpura at diagnosis (P = .0046) and age less than 30 years (P = .0076) were favorable factors for achievement of CR. Predicted 4-year overall survival and EFS rates were 74% and 54%, respectively, and the 4-year predicted DFS rate for 173 CR patients was 62%. Multivariate analysis showed that age less than 30 years (P = .0003) and initial leukocyte count less than 10 x 10(9)/L (P = .0296) were prognostic factors for longer EFS, and initial leukocyte count less than 10.0 x 10(9)/L was a sole significant prognostic factor for longer DFS (P = .0001).
  
  
  CONCLUSIONS
  Our results show that age, hemorrhagic diathesis, and initial leukocyte count are prognostic factors for APL treated with ATRA followed by intensive chemotherapy.
authors.affiliation: Kumamoto University Hospital, Japan. ktcnasou@kaiju.medic.kumamoto-u.ac.jp
authors.forename: N
authors.initials: N
authors.lastname: Asou
authors.forename: K
authors.initials: K
authors.lastname: Adachi
authors.forename: J
authors.initials: J
authors.lastname: Tamura
authors.forename: A
authors.initials: A
authors.lastname: Kanamaru
authors.forename: S
authors.initials: S
authors.lastname: Kageyama
authors.forename: A
authors.initials: A
authors.lastname: Hiraoka
authors.forename: E
authors.initials: E
authors.lastname: Omoto
authors.forename: H
authors.initials: H
authors.lastname: Akiyama
authors.forename: K
authors.initials: K
authors.lastname: Tsubaki
authors.forename: K
authors.initials: K
authors.lastname: Saito
authors.forename: K
authors.initials: K
authors.lastname: Kuriyama
authors.forename: H
authors.initials: H
authors.lastname: Oh
authors.forename: K
authors.initials: K
authors.lastname: Kitano
authors.forename: S
authors.initials: S
authors.lastname: Miyawaki
authors.forename: K
authors.initials: K
authors.lastname: Takeyama
authors.forename: O
authors.initials: O
authors.lastname: Yamada
authors.forename: K
authors.initials: K
authors.lastname: Nishikawa
authors.forename: M
authors.initials: M
authors.lastname: Takahashi
authors.forename: S
authors.initials: S
authors.lastname: Matsuda
authors.forename: S
authors.initials: S
authors.lastname: Ohtake
authors.forename: H
authors.initials: H
authors.lastname: Suzushima
authors.forename: N
authors.initials: N
authors.lastname: Emi
authors.forename: R
authors.initials: R
authors.lastname: Ohno
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D003561:Cytarabine / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome; D014212:Tretinoin / Q000627:therapeutic use*
chemical_list: D003561:Cytarabine; D014212:Tretinoin; D003630:Daunorubicin