title: The impact of medical education and networking on the outcome of leukemia treatment in developing countries. The experience of International Consortium on Acute Promyelocytic Leukemia (IC-APL).
abstract: OBJECTIVE
  Several clinical trials conducted in Europe and US reported favorable outcomes of patients with APL treated with the combination of all trans retinoic acid (ATRA) and anthracyclines. Nevertheless, the results observed in developing countries with  the same regimen was poorer, mainly due to high early mortality mainly due bleeding. The International Consortium on Acute Promyelocytic Leukemia (IC-APL) is an initiative of the International Members Committee of the ASH and the project aims to reduce this gap through the establishment of  international network, which was launched in Brazil, Mexico and Uruguay.
  
  
  METHODS
  The IC-APL treatment protocol is similar to the PETHEMA 2005, but changing idarubicin to daunorubicin. All patients with a suspected diagnosis of APL were immediately started on ATRA, while bone marrow  samples were shipped to a national central lab where genetic verification of the diagnosis was performed. The immunofluorescence using an anti-PML antibody allowed a rapid confirmation of the diagnosis and, the importance of supportive measures was reinforced.
  
  
  RESULTS
  The interim  analysis of 97 patients enrolled in the IC-APL protocol showed that complete remission (CR) rate was 83% and the 2-year overall survival and disease-free survival were 80% and 90%, respectively. Of note, the early mortality rate was reduced to 7.5%.
  
  
  CONCLUSIONS
  The results of IC-APL  demonstrate the impact of educational programs and networking on the improvement of the leukemia treatment outcome in developing countries.
authors.affiliation: Hematology Service, Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil. emrego@hcrp.fmrp.usp.br
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: Rego
authors.forename: Haesook T
authors.initials: HT
authors.lastname: Kim
authors.forename: Guillermo J
authors.initials: GJ
authors.lastname: Ruiz-Argüelles
authors.forename: Maria del Rosario
authors.initials: Mdel R
authors.lastname: Uriarte
authors.forename: Rafael H
authors.initials: RH
authors.lastname: Jacomo
authors.forename: Homero
authors.initials: H
authors.lastname: Gutiérrez-Aguirre
authors.forename: Raul A M
authors.initials: RA
authors.lastname: Melo
authors.forename: Rosane
authors.initials: R
authors.lastname: Bittencourt
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pasquini
authors.forename: Katia
authors.initials: K
authors.lastname: Pagnano
authors.forename: Evandro M
authors.initials: EM
authors.lastname: Fagundes
authors.forename: Maria de Lourdes
authors.initials: Mde L
authors.lastname: Chauffaille
authors.forename: Carlos
authors.initials: C
authors.lastname: Chiattone
authors.forename: Lem
authors.initials: L
authors.lastname: Martinez
authors.forename: Luis A
authors.initials: LA
authors.lastname: Meillón
authors.forename: David
authors.initials: D
authors.lastname: Gómez-Almaguer
authors.forename: Hau
authors.initials: H
authors.lastname: Kwaan
authors.forename: Javier
authors.initials: J
authors.lastname: Garcés-Eisele
authors.forename: Robert
authors.initials: R
authors.lastname: Gallagher
authors.forename: Charlotte M
authors.initials: CM
authors.lastname: Niemeyer
authors.forename: Bob
authors.initials: B
authors.lastname: Lowenberg
authors.forename: Raul
authors.initials: R
authors.lastname: Ribeiro
authors.forename: Francesco
authors.initials: F
authors.lastname: LoCoco
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Sanz
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001853:Bone Marrow / Q000187:drug effects / Q000473:pathology; D001938:Brazil; D003299:Cooperative Behavior; D003630:Daunorubicin / Q000627:therapeutic use*; D003906:Developing Countries; D018572:Disease-Free Survival; D004501:Education, Medical; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D008800:Mexico; D012074:Remission Induction; D016896:Treatment Outcome; D014212:Tretinoin / Q000627:therapeutic use*; D014583:Uruguay
chemical_list: D000970:Antineoplastic Agents; D014212:Tretinoin; D003630:Daunorubicin