title: Role of minimal residual disease monitoring in acute promyelocytic leukemia treated with arsenic trioxide in frontline therapy.
abstract: Data on minimal residual disease (MRD) monitoring in acute promyelocytic leukemia (APL) are available only in the context of conventional all-trans retinoic acid plus chemotherapy regimens. It is recognized that the kinetics of leukemia clearance is different with the use of arsenic trioxide (ATO) in the treatment of APL. We undertook a prospective peripheral blood RT-PCR-based MRD monitoring study on patients with APL treated with a single agent ATO regimen. A total of 151 patients were enrolled in this study. A positive RT-PCR reading at the end of induction therapy was significantly associated on a multivariate analysis with an increased risk of relapse (relative risk = 4.9; P = .034). None of the good risk patients who were RT-PCR negative at the end of induction relapsed. The majority of the relapses (91%) happened within 3 years of completion of treatment. After achievement of molecular remission, the current MRD monitoring strategy was able to predict relapse in 60% of cases with an overall sensitivity and specificity of 60% and 93.2%, respectively. High-risk group patients and those that remain RT-PCR positive at the end of induction are likely to benefit from serial MRD monitoring by RT-PCR for a period of 3 years from completion of therapy.
authors.affiliation: Department of Haematology, Christian Medical College, Vellore, India.
authors.forename: Ezhilarasi
authors.initials: E
authors.lastname: Chendamarai
authors.forename: Poonkuzhali
authors.initials: P
authors.lastname: Balasubramanian
authors.forename: Biju
authors.initials: B
authors.lastname: George
authors.forename: Auro
authors.initials: A
authors.lastname: Viswabandya
authors.forename: Aby
authors.initials: A
authors.lastname: Abraham
authors.forename: Rayaz
authors.initials: R
authors.lastname: Ahmed
authors.forename: Ansu Abu
authors.initials: AA
authors.lastname: Alex
authors.forename: Saravanan
authors.initials: S
authors.lastname: Ganesan
authors.forename: Kavitha M
authors.initials: KM
authors.lastname: Lakshmi
authors.forename: Usha
authors.initials: U
authors.lastname: Sitaram
authors.forename: Sukesh Chandran
authors.initials: SC
authors.lastname: Nair
authors.forename: Mammen
authors.initials: M
authors.lastname: Chandy
authors.forename: Nancy Beryl
authors.initials: NB
authors.lastname: Janet
authors.forename: Vivi M
authors.initials: VM
authors.lastname: Srivastava
authors.forename: Alok
authors.initials: A
authors.lastname: Srivastava
authors.forename: Vikram
authors.initials: V
authors.lastname: Mathews
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000627:therapeutic use*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques; D008991:Monitoring, Physiologic / Q000379:methods; D020360:Neoadjuvant Therapy; D018365:Neoplasm, Residual; D015514:Oncogene Proteins, Fusion / Q000032:analysis / Q000235:genetics; D010087:Oxides / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D001152:Arsenicals; D015514:Oncogene Proteins, Fusion; D010087:Oxides; C093476:promyelocytic leukemia-retinoic acid receptor alpha fusion oncoprotein; D000077237:Arsenic Trioxide