title: Quantification of PML/RARa transcript after induction predicts outcome in children with acute promyelocytic leukemia.
abstract: Reports on the use of the real-time quantitative polymerase chain reaction (RQ-PCR) for childhood acute promyelocytic leukemia (APL) therapy are scarce. This study describes the prognostic significance of quantification of the PML-RARa transcript in children with APL. Since January 2004, we have analyzed 40 children treated with all-trans-retinoic acid ± arsenic trioxide in induction. Thirty-nine patients (97.5%) entered complete remission. The 5-year rates of disease-free survival (DFS) and overall survival in these patients were 73.1 and 91.4%, respectively. By employing a standardized RQ-PCR protocol for minimal residual disease (MRD) monitoring, we determined that less than 1 normalized copy number (NCN) after induction indicates higher probability of a more favorable treatment outcome. After induction therapy, thirteen out of 38 (34.2%) patients in hematologic remission showed a negative RQ-PCR result (less than 1 NCN), which was correlated with the lower probability of relapse (100 and 55.2% DFS at 5 years in the negative and positive RQ-PCR groups, respectively; P = 0.018). PML/RARa-based MRD monitoring by RQ-PCR may allow us to identify subgroups of patients at low risk of relapse after induction.
authors.affiliation: State Key Laboratory of Experimental Hematology, Department of Pediatrics, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, People's Republic of China.
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.forename: Zeng
authors.initials: Z
authors.lastname: Cao
authors.forename: Yao
authors.initials: Y
authors.lastname: Zou
authors.forename: Min
authors.initials: M
authors.lastname: Ruan
authors.forename: Qinghua
authors.initials: Q
authors.lastname: Li
authors.forename: Jianxiang
authors.initials: J
authors.lastname: Wang
authors.forename: Xiaofan
authors.initials: X
authors.lastname: Zhu
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000175:diagnosis* / Q000188:drug therapy* / Q000235:genetics; D008297:Male; D015999:Multivariate Analysis; D018365:Neoplasm, Residual; D015514:Oncogene Proteins, Fusion / Q000235:genetics*; D010087:Oxides / Q000627:therapeutic use*; D011379:Prognosis; D060888:Real-Time Polymerase Chain Reaction; D012074:Remission Induction; D014158:Transcription, Genetic / Q000187:drug effects; D016896:Treatment Outcome; D014212:Tretinoin / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D001152:Arsenicals; D015514:Oncogene Proteins, Fusion; D010087:Oxides; C093476:promyelocytic leukemia-retinoic acid receptor alpha fusion oncoprotein; D014212:Tretinoin; D000077237:Arsenic Trioxide