title: Improving acute promyelocytic leukemia (APL) outcome in developing countries through networking, results of the International Consortium on APL.
abstract: Thanks to modern treatment with all-trans retinoic acid and chemotherapy, acute promyelocytic leukemia (APL) is now the most curable type of leukemia. However, this progress has not yielded equivalent benefit in developing countries. The International Consortium on Acute Promyelocytic Leukemia (IC-APL) was established to create a network of institutions in developing countries that would exchange experience and data and receive support from well-established US and European cooperative groups. The IC-APL formulated expeditious diagnostic, treatment, and supportive guidelines that were adapted to local circumstances. APL was chosen as a model disease because of the potential impact on improved diagnosis and treatment. The project included 4 national coordinators and reference laboratories, common clinical record forms, 5 subcommittees, and laboratory and data management training programs. In addition, participating institutions held regular virtual and face-to-face meetings. Complete hematological remission was achieved in 153/180 (85%) patients and 27 (15%) died during induction. After a median follow-up of 28 months, the 2-year cumulative incidence of relapse, overall survival (OS), and disease-free survival (DFS) were 4.5%, 80%, and 91%, respectively. The establishment of the IC-APL network resulted in a decrease of almost 50% in early mortality and an improvement in OS of almost 30% compared with historical controls, resulting in OS and DFS similar to those reported in developed countries.
authors: Hematology/Oncology Division, Department of Internal Medicine, Medical School of Ribeirão Preto and Center for Cell Based Therapy, University of São Paulo, Ribeirão Preto, Brazil. emrego@hcrp.fmrp.usp.br
authors: Eduardo M
authors: EM
authors: Rego
authors: Haesook T
authors: HT
authors: Kim
authors: Guillermo J
authors: GJ
authors: Ruiz-Argüelles
authors: Maria Soledad
authors: MS
authors: Undurraga
authors: Maria del Rosario
authors: Mdel R
authors: Uriarte
authors: Rafael H
authors: RH
authors: Jacomo
authors: Homero
authors: H
authors: Gutiérrez-Aguirre
authors: Raul A M
authors: RA
authors: Melo
authors: Rosane
authors: R
authors: Bittencourt
authors: Ricardo
authors: R
authors: Pasquini
authors: Katia
authors: K
authors: Pagnano
authors: Evandro M
authors: EM
authors: Fagundes
authors: Maria de Lourdes
authors: Mde L
authors: Chauffaille
authors: Carlos S
authors: CS
authors: Chiattone
authors: Lem
authors: L
authors: Martinez
authors: Luis A
authors: LA
authors: Meillón
authors: David
authors: D
authors: Gómez-Almaguer
authors: Hau C
authors: HC
authors: Kwaan
authors: Javier
authors: J
authors: Garcés-Eisele
authors: Robert
authors: R
authors: Gallagher
authors: Charlotte M
authors: CM
authors: Niemeyer
authors: Stanley L
authors: SL
authors: Schrier
authors: Martin
authors: M
authors: Tallman
authors: David
authors: D
authors: Grimwade
authors: Arnold
authors: A
authors: Ganser
authors: Nancy
authors: N
authors: Berliner
authors: Raul C
authors: RC
authors: Ribeiro
authors: Francesco
authors: F
authors: Lo-Coco
authors: Bob
authors: B
authors: Löwenberg
authors: Miguel A
authors: MA
authors: Sanz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002677:Chile / Q000453:epidemiology; D019058:Community Networks / Q000458:organization & administration*; D032921:Consensus; D003906:Developing Countries / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D038622:Internationality; D015473:Leukemia, Promyelocytic, Acute / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D011379:Prognosis; D058996:Quality Improvement / Q000458:organization & administration*; D016019:Survival Analysis; D016896:Treatment Outcome; D014583:Uruguay / Q000453:epidemiology; D055815:Young Adult