title: A survival study and prognostic factors analysis on acute promyelocytic leukemia at a single center.
abstract: This study was aimed to investigate the factors influencing long-term survival on patients with acute promyelocytic leukemia. Here, we present a single center retrospective study with long-term follow-up to explore the prognostic factors and a rationale of the using of ATRA, chemotherapy and As(2)O(3) in the treatment of newly diagnosed APL patients. In total, 222 patients, 184 achieved complete remission (CR) with the CR rate of 82.88% and 22 patients died during early induction therapy with the early-death-rate of 10%. Total 171 newly diagnosed APL patients entering CR were retrospectively analyzed from November 1989 to December 2004,with a median follow-up of 36 months (6-185 months). Univariate and multivariate analysis of eight factors potentially influencing survival and prognosis were carried out with Log-Rank and Cox regression method, including sex, age, initial WBC count, the level of lactic dehydrogenase (LDH), first induction regimen, days from induction therapy to CR, post-remission therapy and the status of PML-RAR alpha fusion gene by reverse transcription-polymerase chain reaction (RT-PCR). The results showed that the estimated 5-year overall survival (OS) and relapse-free survival (RFS) were 80.9+/-4.0 and 71.0+/-4.0%, respectively. Univariate analyses showed that initial WBC count, first induction regimen, days from induction therapy to CR, post-remission therapy regimen and the status of PML-RAR alpha in remission were important prognostic factors for long-term survival. Multivariate study showed that only post-remission therapy regimen was associated with RFS and OS. It is concluded that the post-remission treatment combining ATRA, As(2)O(3) and chemotherapy would significantly improve the long-term survival of APL patients achieving CR(1).
authors.affiliation: Institute of Haematology and Blood Diseases Hospital, Chinese Academy of Medical Science and Chinese Union Medical University, 288 Nanjing Road, Tianjin 300020, China.
authors.forename: Li
authors.initials: L
authors.lastname: Xin
authors.forename: Sun
authors.initials: S
authors.lastname: Wan-jun
authors.forename: Li
authors.initials: L
authors.lastname: Zeng-jun
authors.forename: Zhao
authors.initials: Z
authors.lastname: Yao-zhong
authors.forename: Li
authors.initials: L
authors.lastname: Yun-tao
authors.forename: Li
authors.initials: L
authors.lastname: Yan
authors.forename: Wan
authors.initials: W
authors.lastname: Chang-chun
authors.forename: Li
authors.initials: L
authors.lastname: Qiao-chuan
authors.forename: Yang
authors.initials: Y
authors.lastname: Ren-chi
authors.forename: Han
authors.initials: H
authors.lastname: Ming-zhe
authors.forename: Wang
authors.initials: W
authors.lastname: Jian-xiang
authors.forename: Qiu
authors.initials: Q
authors.lastname: Lu-gui
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015514:Oncogene Proteins, Fusion / Q000235:genetics; D010087:Oxides / Q000008:administration & dosage; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014212:Tretinoin / Q000008:administration & dosage
chemical_list: D001152:Arsenicals; D015514:Oncogene Proteins, Fusion; D010087:Oxides; C093476:promyelocytic leukemia-retinoic acid receptor alpha fusion oncoprotein; D014212:Tretinoin; D000077237:Arsenic Trioxide