title: Evolving characteristics and outcome of secondary acute promyelocytic leukemia (APL): A prospective analysis by the French-Belgian-Swiss APL group.
abstract: BACKGROUND
  Reports of patients with secondary acute promyelocytic leukemia (APL) have increased in recent years, particularly for those who received treatment with mitoxantrone, and retrospective studies have suggested that their characteristics and outcomes were similar to those of patients with de novo APL.
  
  
  METHODS
  The authors investigated patients with de novo and secondary APL who were included in the ongoing APL-2006 trial. Patients with secondary APL who were included in that trial also were compared with a previous retrospective cohort of patients with secondary APL.
  
  
  RESULTS
  In the APL-2006 trial, 42 of 280 patients (15%) had secondary APL. Compared with the retrospective cohort, patients with secondary APL in the APL-2006 trial had a lower incidence of prior breast carcinoma (35.7% vs 57%; P = .03) and a higher incidence of prior prostate carcinoma (26.2% vs 4.7%; P < .001). Treatment of the primary tumor in the APL-2006 trial less frequently included combined radiochemotherapy (28.6% vs 47.2%; P = .044) and no mitoxantrone (0% vs 46.7%; P = .016) but more frequently included anthracyclines (53.3% vs 38.3%; P = .015). In the APL-2006 trial, patients who had secondary APL, compared with those who had de novo APL, were older (mean, 60.2 years vs 48.7 years, respectively; P < .0001) but had a similar complete response rate (97.6% vs 90.3%, respectively), cumulative incidence of relapse (0% vs 1.8%, respectively), and overall survival (92.3% vs 90.9%, respectively) at 18 months.
  
  
  CONCLUSIONS
  Although the incidence of secondary APL appears to be stable over time, evolving strategies for the treatment of primary cancers have reduced its occurrence among breast cancer patients but have increased its incidence among patients with prostate cancer. The current results confirm prospectively that patients with secondary APL have characteristics and outcomes similar to those of patients with de novo APL.
authors.affiliation: Department of Hematology, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 13, Bobigny, France.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Braun
authors.affiliation: Department of Hematology, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 13, Bobigny, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Cereja
authors.affiliation: Department of Biostatistics, St Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 7, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chevret
authors.affiliation: Department of Hematology, St Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 7, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Raffoux
authors.affiliation: Deparment of Hematology, Hospital Dunkerque, Dunkerque, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Beaumont
authors.affiliation: Department of Hematology, Roubaix Hospital, Roubaix, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Detourmignies
authors.affiliation: Department of Hematology, Haut-Lévèque University Hospital, Pessac, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Pigneux
authors.affiliation: Department of Hematology, Lyon University Hospital, Lyon, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Thomas
authors.affiliation: Department of Hematology, Limoges University Hospital, Limoges, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Bordessoule
authors.affiliation: Department of Hematology, Nancy University Hospital, Nancy, France.
authors.forename: Agnès
authors.initials: A
authors.lastname: Guerci
authors.affiliation: Department of Hematology, Rennes University Hospital, Rennes, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lamy
authors.affiliation: Department of Hematology, Purpan University Hospital, Toulouse, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Recher
authors.affiliation: Department of Hematology, St Louis-Brussels University Hospital, Brussels, Belgium.
authors.forename: Xavier
authors.initials: X
authors.lastname: Poiré
authors.affiliation: Department of Hematology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Tournilhac
authors.affiliation: Department of Hematology, University Hospital, Lausanne, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Spertini
authors.affiliation: National Institute of Health and Medical Research (INSERM) Unit 940, St Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 7, Paris, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Chomienne
authors.affiliation: Department of Hematology, St Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 7, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Degos
authors.affiliation: Department of Hematology, St Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 7, Paris, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Dombret
authors.affiliation: Department of Hematology, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 13, Bobigny, France.|Department of Hematology Seniors, St Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 7, Paris, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Adès
authors.affiliation: Department of Hematology, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 13, Bobigny, France.|Department of Hematology Seniors, St Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 7, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Fenaux
mesh_terms: D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001530:Belgium / Q000453:epidemiology; D059248:Chemoradiotherapy; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D015473:Leukemia, Promyelocytic, Acute / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D011446:Prospective Studies; D012008:Recurrence; D013557:Switzerland / Q000453:epidemiology
chemical_list: D018943:Anthracyclines; D008942:Mitoxantrone
keywords: acute promyelocytic leukemia; breast cancer; prostate cancer; secondary acute myeloid leukemia