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RESEARCH PRODUCT
Central nervous system involvement at first relapse in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and anthracycline monochemotherapy without intrathecal prophylaxis
Concha RivasJosé GonzálezMarcos GonzálezMiguel A. SanzGuillermo DebenJordi EsteveJavier De La SernaPau MontesinosInmaculada PérezSalut BrunetIsolda FernándezJoaquín Díaz-mediavillaChelo RayonSilvia NegriMar TormoJosé D. GonzálezVicente RubioMaricruz ViguriaVirginia PratesJuan BerguaBob Löwenbergsubject
:Chemicals and Drugs::Organic Chemicals::Hydrocarbons::Hydrocarbons Cyclic::Hydrocarbons Aromatic::Polycyclic Hydrocarbons Aromatic::Naphthacenes::Anthracyclines::Daunorubicin::Idarubicin [Medical Subject Headings]:Diseases::Pathological Conditions Signs and Symptoms::Pathologic Processes::Disease Attributes::Recurrence [Medical Subject Headings]Male:Named Groups::Persons::Age Groups::Adult::Middle Aged [Medical Subject Headings]idarubicinGastroenterology:Analytical Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk Factors [Medical Subject Headings]:Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings]Central Nervous System NeoplasmsLeukemia Promyelocytic AcuteRecurrenceRisk FactorsCumulative incidenceAntibiotics AntineoplasticHematologyMiddle Agedall-trans retinoic acidLeukemiamedicine.anatomical_structure:Named Groups::Persons::Age Groups::Adolescent [Medical Subject Headings]Femalemedicine.drugAcute promyelocytic leukemiaAdultcentral nervous system relapsemedicine.medical_specialty:Diseases::Neoplasms::Neoplasms by Histologic Type::Leukemia::Leukemia Myeloid::Leukemia Myeloid Acute [Medical Subject Headings]AnthracyclineAdolescentCentral nervous system:Check Tags::Male [Medical Subject Headings]TretinoinNeoplasias del sistema nervioso centralCentral nervous system diseaseTretinoinInternal medicine:Named Groups::Persons::Age Groups::Adult [Medical Subject Headings]medicineIdarubicinHumans:Named Groups::Persons::Age Groups::Adult::Aged [Medical Subject Headings]Letters to the Editor:Chemicals and Drugs::Organic Chemicals::Hydrocarbons::Hydrocarbons Acyclic::Alkenes::Polyenes::Carotenoids::Retinoids [Medical Subject Headings]Leucemia promielocítica agudaAgedAntibióticos antineoplásicosbusiness.industryprognostic factors:Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Antineoplastic Agents::Antibiotics Antineoplastic [Medical Subject Headings]acute promyelocytic leukemiamedicine.diseaseSurgery:Diseases::Neoplasms::Neoplasms by Site::Nervous System Neoplasms::Central Nervous System Neoplasms [Medical Subject Headings]:Check Tags::Female [Medical Subject Headings]businessIdarubicindescription
Background The prevalence of and risk factors for central nervous system recurrence in patients with acute promyelocytic leukemia are not well established and remain a controversial matter. Design and Methods Between 1996 and 2005, 739 patients with newly diagnosed acute promyelocytic leukemia enrolled in two consecutive trials (PETHEMA LPA96 and LPA99) received induction therapy-with all-trans retinoic acid and idarubicin. Consolidation therapy comprised three courses of anthracycline monochemotherapy (LPA96), with all-trans retinoic acid and reinforced doses of idarubicin in patients with an intermediate or high risk of relapse (LPA99). Central nervous system prophylaxis was not given. Results Central nervous system relapse was documented in 11 patients. The 5-year cumulative incidence of central nervous system relapse was 1.7% (LPA96 3.2% and LPA99 1.2%; p=0.09). The cumulative incidence was 0%, 0.8%, and 5.5% in low-, intermediate-, and high-risk patients, respectively. Relapse risk score (p=0.0001) and the occurrence of central nervous system hemorrhage during induction (5-year cumulative incidence 18.7%, p=0.006) were independent risk factors for central nervous system relapse. Conclusions This study shows a low incidence of central nervous system relapse in patients with acute promyelocytic leukemia following therapy with all-trans retinoic acid and anthracycline without specific central nervous system prophylaxis. Central nervous system relapse was significantly associated with high white blood cell counts and prior central nervous system hemorrhage, which emerged as independent prognostic factors.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2009-01-01 |