title: Long-term efficacy and safety of arsenic trioxide for first-line treatment of elderly patients with newly diagnosed acute promyelocytic leukemia.
abstract: BACKGROUND
  The prognosis of acute promyelocytic leukemia (APL) in the elderly is poorer than that of younger patients after treatment with all-trans retinoic acid plus chemotherapy, which is the current standard therapy for APL. A significantly higher mortality during consolidation therapy was found, which is mainly due to deaths from sepsis following chemotherapy-induced myelosuppression.
  
  
  METHODS
  A total of 33 patients aged 60 years or older with de novo APL were treated with single-agent arsenic trioxide (ATO) for remission induction and postremission therapy. The postremission therapy continued for up to 4 years.
  
  
  RESULTS
  Twenty-nine patients (87.9%) achieved a hematologic complete remission, and the most common adverse event during remission induction was leukocytosis (63.6%). Definite differentiation syndrome was observed in 5 patients. Nonhematologic adverse events were all manageable and reversible. Twenty-eight patients proceeded to postremission therapy. Adverse effects during postremission therapy were mild, transient, and no treatment was required. No patients died from ATO-related toxicities. With a median follow-up of 99 months, the 10-year cumulative incidence of relapse, overall survival, disease-free survival, and cause-specific survival were 10.3%, 69.3%, 64.8%, and 84.8%, respectively, which are comparable with those in the younger APL partners. No significant risks for development of chronic arsenicosis or second malignancy were observed during the follow-up period.
  
  
  CONCLUSIONS
  The results indicate that the single-agent ATO regimen is safe and effective with long-term durable remission, and could be used as first-line treatment for elderly patients with de novo APL.
authors.affiliation: Central Laboratory, the First Affiliated Hospital, Harbin Medical University, Heilongjiang, China.
authors.forename: Yingmei
authors.initials: Y
authors.lastname: Zhang
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Zhang
authors.forename: Jinmei
authors.initials: J
authors.lastname: Li
authors.forename: Limin
authors.initials: L
authors.lastname: Li
authors.forename: Xueying
authors.initials: X
authors.lastname: Han
authors.forename: Lina
authors.initials: L
authors.lastname: Han
authors.forename: Longhu
authors.initials: L
authors.lastname: Hu
authors.forename: Shuye
authors.initials: S
authors.lastname: Wang
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Zhao
authors.forename: Xiaoxia
authors.initials: X
authors.lastname: Li
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.forename: Shengjin
authors.initials: S
authors.lastname: Fan
authors.forename: Chengfang
authors.initials: C
authors.lastname: Lv
authors.forename: Yinghua
authors.initials: Y
authors.lastname: Li
authors.forename: Yanhua
authors.initials: Y
authors.lastname: Su
authors.forename: Hui
authors.initials: H
authors.lastname: Zhao
authors.forename: Xin
authors.initials: X
authors.lastname: Zhang
authors.forename: Jin
authors.initials: J
authors.lastname: Zhou
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000009:adverse effects / Q000627:therapeutic use*; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010087:Oxides / Q000009:adverse effects / Q000627:therapeutic use*; D011379:Prognosis; D012008:Recurrence
chemical_list: D000970:Antineoplastic Agents; D001152:Arsenicals; D010087:Oxides; D000077237:Arsenic Trioxide