title: Use of all-trans retinoic acid in combination with arsenic trioxide for remission induction in patients with newly diagnosed acute promyelocytic leukemia and for consolidation/maintenance in CR patients.
abstract: In the present study, 90 patients with newly diagnosed acute promyelocytic leukemia (APL) were studied for all-trans retinoic acid (ATRA) and arsenic trioxide (As(2)O(3)) combination treatment in remission induction and postremission therapy. In addition, 20 APL patients who had achieved complete remission (CR) with an ATRA-based regimen received ATRA/As(2)O(3) combination for consolidation and maintenance were also enrolled. The results showed that ATRA/As(2)O(3) combination therapy yielded a high CR rate of 93.3% and a significantly shorter time to enter CR (median: 31 days; range: 18-59 days) compared to the ATRA-based regimen (n = 72; median: 39 days; range: 25-62 days). With the ATRA/As(2)O(3) combination for CR maintaining, regardless of the way by which CR was attained, the relapse-free survival was significantly better than with an ATRA plus cytotoxic chemotherapy regimen (92.9 +/- 3.2% vs. 72.4 +/- 7.6%, for the 3-year Kaplan-Meier estimate of relapse-free survival). The drug toxicity profile showed that with the use of As(2)O(3), the incidence of hepatotoxicity was obviously high during remission induction but decreased significantly during postremission treatment. We conclude that APL patients may benefit from the early use of the combination of ATRA and As(2)O(3), in either remission induction or consolidation/maintenance.
authors.affiliation: Division of Hematology, Institute of Molecular Hematology, Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Chong-Wen
authors.initials: CW
authors.lastname: Dai
authors.forename: Guang-Sen
authors.initials: GS
authors.lastname: Zhang
authors.forename: Jian-Kai
authors.initials: JK
authors.lastname: Shen
authors.forename: Wen-Li
authors.initials: WL
authors.lastname: Zheng
authors.forename: Min-Fei
authors.initials: MF
authors.lastname: Pei
authors.forename: Yun-Xiao
authors.initials: YX
authors.lastname: Xu
authors.forename: Yi-Xiong
authors.initials: YX
authors.lastname: Cao
authors.forename: Yan
authors.initials: Y
authors.lastname: Yi
authors.forename: Jun-Jie
authors.initials: JJ
authors.lastname: Yang
authors.forename: Hong-Ling
authors.initials: HL
authors.lastname: Peng
authors.forename: Hai-Ying
authors.initials: HY
authors.lastname: Zhong
authors.forename: Rui-Juan
authors.initials: RJ
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010087:Oxides / Q000008:administration & dosage / Q000009:adverse effects; D012074:Remission Induction / Q000379:methods; D015996:Survival Rate; D013997:Time Factors; D014212:Tretinoin / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D001152:Arsenicals; D010087:Oxides; D014212:Tretinoin; D000077237:Arsenic Trioxide