Early onset of chemotherapy can reduce the incidence of ATRA syndrome in newly diagnosed acute promyelocytic leukemia (APL) with low white blood cell counts: results from APL 93 trial.
Treatment combining ATRA and chemotherapy (CT) has improved the outcome of APL patients, by comparison with CT alone. ATRA syndrome is a life-threatening complication of ATRA treatment whose prophylaxis remains somewhat controversial. In APL93 trial, newly diagnosed APL patients </=65 years and with initial WBC counts below 5000/mm(3) were randomized between ATRA until CR achievement followed by CT (ATRA --> CT) and ATRA with early addition of CT, on day 3 of ATRA treatment (ATRA + CT). The incidence of ATRA syndrome in the ATRA --> CT arm was 18% (22/122) as compared to 9.2% (17/184) in the ATRA + CT arm (P = 0.035). In the ATRA --> CT arm, three (2.5%) patients died from ATRA syndrome, as compared to one (0.5%) in the ATRA + CT group. Early addition of chemotherapy to ATRA in newly diagnosed APL with low WBC counts significantly reduced the incidence of ATRA syndrome.
de Botton
S
S
Chevret
S
S
Coiteux
V
V
Dombret
H
H
Sanz
M
M
San Miguel
J
J
Caillot
D
D
Vekhoff
A
A
Gardembas
M
M
Stamatoulas
A
A
Conde
E
E
Guerci
A
A
Gardin
C
C
Fey
M
M
Cony Makhoul
D
D
Reman
O
O
de la Serna
J
J
Lefrere
F
F
Chomienne
C
C
Degos
L
L
Fenaux
P
P
D000328:Adult; D017668:Age of Onset; D000970:Antineoplastic Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000097:blood / Q000188:drug therapy*; D007958:Leukocyte Count; D007970:Leukopenia / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013577:Syndrome; D016896:Treatment Outcome; D014212:Tretinoin / Q000009:adverse effects* / Q000627:therapeutic use*
D000970:Antineoplastic Agents; D014212:Tretinoin