scholarly journals Herbo-mineral ayurvedic treatment in a high risk acute promyelocytic leukemia patient with second relapse: 12 years follow up

2010 ◽  
Vol 1 (3) ◽  
pp. 215 ◽  
Author(s):  
Balendu Prakash ◽  
PurvishM Parikh ◽  
SanjoyK Pal
Keyword(s):  
High Risk ◽  
Acute Promyelocytic Leukemia ◽  
Promyelocytic Leukemia ◽  
Acute Promyelocytic Leukemia Patient ◽  
Leukemia Patient ◽  
Ayurvedic Treatment

Risk-Adapted Treatment of Acute Promyelocytic Leukemia: Updated Results of the Spanish PETHEMA LPA99 Trial Using ATRA and Anthracycline Monochemotherapy.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 590-590 ◽  
Author(s):  
Miguel A. Sanz ◽  
Pau Montesinos ◽  
Edo Vellenga ◽  
Chelo Rayon ◽  
Ricardo Parody ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Promyelocytic Leukemia ◽  
Disease Free Survival ◽  
Promyelocytic Leukemia ◽  
Consolidation Therapy ◽  
Number Of Patients ◽  
Risk Patients ◽  
Low Toxicity ◽  
High Degree

Abstract Background: A first report of the PETHEMA LPA99 trial in acute promyelocytic leukemia (APL) showed that a risk-adapted treatment strategy combining ATRA and anthracycline alone for induction and consolidation results in high antileukemic efficacy and low toxicity. We report here an updated analysis of this trial including a significantly higher number of patients and longer follow-up. Methods: From November 1999 to July 2005, 564 patients (median age 40 years, range 2–83) with APL received induction with ATRA (45 mg/m2/d) until CR and idarubicin (12 mg/m2/d) on days 2, 4, 6 and 8. Patients in CR received 3 monthly courses of risk-adapted consolidation therapy as follows: “low-risk” patients (WBC <10×109/l and platelets >40×109/l), idarubicin 5 mg/m2/d × 4 (course #1), mitoxantrone 10 mg/m2/d × 5 (course #2), and idarubicin 12 mg/m2/d × 1 (course #3); “intermediate-risk “ (WBC <10×109/l and platelet <40×109/l) and “high-risk” (WBC >10×109/l) patients received ATRA (45 mg/m2/d × 15) in combination with reinforced chemotherapy (Idarubicin 7 mg/m2/d in the course #1 and two days instead of one in the course #3). Maintenance therapy consisted of 50 mg/m2/d mercaptopurine orally, 15 mg/m2/week methotrexate intramuscularly, and 45 mg/m2/d ATRA for 15 days every 3 months. Results: CR was achieved in 511 patients (91%). Except for three cases labelled as resistant, of the remaining 50 patients 56%, 24%, 16% and 4% died due to hemorrhage, infection, retinoic acid syndrome, and acute myocardial infarction, respectively. Multivariate analysis showed that WBC >10×109/l, age >60 years, male gender, and serum creatinine >1.4 mg/dl at presentation had independent predictive value of death during induction. The median follow-up of the cohort was 57 months (range 20–94 months). Thirteen patients (median age 72 years, range 4–81) died in remission and 99% of patients completed the entire assigned therapy. Thirty-six patients presented haematological relapse, 16 molecular relapse, and 8 secondary myelodysplastic syndrome or acute myeloid leukemia. Overall, the 5-year cumulative incidence of relapse (CIR), disease-free survival, and overall survival were 11%, 85%, and 84%, respectively. The 5-year CIR for low-, intermediate- and high-risk patients were 4%, 7% and 28%, respectively. Conclusions: A risk-adapted strategy combining ATRA and anthracycline monochemotherapy for induction and consolidation therapy results in high antileukemic efficacy, low toxicity and a high degree of compliance in newly diagnosed APL.

scholarly journals Effective Treatment of Acute Promyelocytic Leukemia With All-Trans-Retinoic Acid, Arsenic Trioxide, and Gemtuzumab Ozogamicin

2009 ◽  
Vol 27 (4) ◽  
pp. 504-510 ◽  
Author(s):  
Farhad Ravandi ◽  
Eli Estey ◽  
Dan Jones ◽  
Stefan Faderl ◽  
Susan O'Brien ◽  
...  
Keyword(s):  
Retinoic Acid ◽  
High Risk ◽  
Arsenic Trioxide ◽  
Acute Promyelocytic Leukemia ◽  
Gemtuzumab Ozogamicin ◽  
Promyelocytic Leukemia ◽  
Platelet Recovery ◽  
Trans Retinoic Acid ◽  
All Trans Retinoic Acid

Purpose We examined the outcome of patients with newly diagnosed acute promyelocytic leukemia (APL) treated with all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO) with or without gemtuzumab ozogamicin (GO) but without traditional cytotoxic chemotherapy. Patients and Methods From February 2002 to March 2008, 82 patients with APL were treated with a combination of ATRA plus ATO. The first cohort of 65 patients received ATRA and ATO (beginning on day 10 of ATRA). High-risk patients (WBCs ≥ 10 × 109/L) received GO on the first day. From July 2007, the second cohort of 17 patients received ATRA and ATO concomitantly on day 1. They also received GO on day 1, if high risk, and if their WBC increased to more than 30 × 109/L during induction. Monitoring for PML-RARA fusion gene was conducted after induction and throughout consolidation and follow-up. Results Overall, 74 patients achieved complete remission (CR) and one achieved CR without full platelet recovery after the induction, for a response rate of 92%. Seven patients died at a median of 4 days (range, 1 to 24 days) after inclusion in the study from disease-related complications. The median follow-up is 99 weeks (range, 2 to 282 weeks). Among the responding patients, three experienced relapse at 39, 52, and 53 weeks. Three patients died after being in CR for 14, 21, and 71 weeks, all from a second malignancy. The estimated 3-year survival rate is 85%. Conclusion The combination of ATRA and ATO (with or without GO) as initial therapy for APL was effective and safe and can substitute chemotherapy-containing regimens.

scholarly journals High Risk Apml Treated Successfully with Four Cycles of ATO and ATRA Combination in Resource Constrained Settings

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3322-3322 ◽  
Author(s):  
Subhash Varma ◽  
Uday Yanamandra ◽  
Alka Khadwal ◽  
Gaurav Prakash ◽  
Vikas Suri ◽  
...  
Keyword(s):  
Bone Marrow ◽  
High Risk ◽  
Acute Promyelocytic Leukemia ◽  
Median Duration ◽  
Survival Curve ◽  
Promyelocytic Leukemia ◽  
Once Daily ◽  
Kaplan Meier

Abstract Background: Acute promyelocytic leukemia (APML) is amongst the most curable malignancies with survival close to 80% [1]. Combination of all-trans- retinoic-acid (ATRA) and anthracyclines is the current standard of care for high-risk APML patients [2]. Literature on combination of arsenic trioxide (ATO) with ATRA in high risk APML, the number of cycles and long-term toxicity of ATO is scarce [3]. Methods: It is a single center retrospective study. Diagnosis of APML was made by bone marrow (BM) and PML-RARα detection by RT PCR. Patients with high risk APML (defined as TLC>10000/µL) enrolled after 2006 were included and treated with combination of ATO/ATRA as per the protocol (Fig. 1). RT PCR for PML-RARα was done after remission induction, completion of consolidation and 6 monthly thereafter. Results: A total of 39 high risk APML patients were treated during the study period (25 males, 14 females) with median age 31y (range 15-50). Cohort was poorly educated (median - 10th standard) and were from poor socioeconomic strata (mean monthly income - INR 7000, 1USD=65INR). The major presenting complaints were bleeding manifestation and fever (78%, 84% respectively) for a median duration of 30 days (range 3-90d, 95% CI - 14.8). Baseline clinical, hematological and coagulation parameters are as enumerated in Table1.Table 1.Descriptive statistics high risk APML patients at baselineMinimumMaximumMeanStd. DeviationHeight (cm)148180163.109.91Weight (kg)35.080.055.4711.75Peripheral blood smear features at presentationHemoglobin (g/dL)4.113.37.132.36Leucocyte count (/µL)107001237004597635230.92Platelet ( x 109/L)625528944.76Blasts and Promyelocytes (%)010070.8535.57Bone marrow findings at diagnosisBlasts09417.5827.43Promyelocytes29670.2423.14Coagulation parameters at presentationPT (s)113120.104.22aPTT (s)203327.793.34Fibrinogen (g/L)0.683.841.890.81 Complications: DIC was present in 66.7% of the patient at baseline with the median duration to resolution of DIC on ATO/ATRA being 7 days (range 4 - 25d). Thrombosis was present in 17.1% of the patients. Differentiation syndrome (DS) was seen in 59% (n-23) of the patients at mean duration of 5.6 days of starting therapy (range: -4 to 14d). Twenty one percent of patients with DS (n-5) succumbed to death and all these patients had features of spontaneous DS prior to starting ATO/ATRA. Deaths due to differentiation were primarily seen in during the first week of starting therapy (median-D4). In rest all cases DS improved with dexamethasone 10mg BD and interruption of ATO/ATRA. Outcomes: Median duration to hematological remission was 31days (range: 2-59d). Bone marrow remission was attained in all patients alive at the end of induction. Molecular remission was attained in 100% of these patients. OS was 84.1% (Fig 2A). Log survival curve (Fig 2B) elucidates the fact that those patients who survived the induction therapy had no mortality further during the course of illness. Event free survival (EFS) was 84.1%, same as OS suggesting no patients relapsed during the therapy. Mean follow up of the cohort was 910 days (range 1 - 2681d, SD - 854.3d). Long term follow up these patients showed no evidence of secondary malignancy as feared by most authors for giving ATO therapy. Conclusions: Four cycles of ATRA/ATO with two years of maintenance therapy produces long-term remission with low risk of relapse and no arsenic induced long term toxicities in patients with high risk APML. REFERENCES: 1. Sanz MA, Lo-Coco F. Modern approaches to treating acute promyelocytic leukemia. J Clin Oncol 2011;29:495-503. 2. National Comprehensive Cancer Network (nccn). NCCN Clinical Practice Guidelines in Oncology: Acute Myeloid Leukemia. Ver. 2.2013. Fort Washington, PA: nccn; 2013. 3. Seftel MD, Barnett MJ, Couban S, Leber B, Storring J, Assaily W, Fuerth B, Christofides A, Schuh AC. A Canadian consensus on the management of newly diagnosed and relapsed acute promyelocytic leukemia in adults. Curr Oncol. 2014 Oct;21(5):234-50. Figure 1. Protocol of ATO/ATRA therapy. Legend: BM - Bone marrow, Consol - Consolidation, PCR - Polymerase chain reaction, DIC - disseminated intravascular coagulation, ANC - absolute neutrophil count, Wk - week, OD - once daily. Figure 1. Protocol of ATO/ATRA therapy. Legend: BM - Bone marrow, Consol - Consolidation, PCR - Polymerase chain reaction, DIC - disseminated intravascular coagulation, ANC - absolute neutrophil count, Wk - week, OD - once daily. Figure 2. Kaplan Meier curves (A) Cumulative survival curve showing 84% OS. (B) log survival curve showing no mortality after the initial 90 days after starting therapy. Figure 2. Kaplan Meier curves (A) Cumulative survival curve showing 84% OS. (B) log survival curve showing no mortality after the initial 90 days after starting therapy. Disclosures No relevant conflicts of interest to declare.

scholarly journals Omission of Maintenance in Patients with High-Risk Acute Promyelocytic Leukemia (APL) in the Era of ATRA/Arsenic Consolidation

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5192-5192
Author(s):  
Gaurav Shah ◽  
Fady M. Mikhail ◽  
Harry P. Erba ◽  
Nikolaos Papadantonakis
Keyword(s):  
Bone Marrow ◽  
High Risk ◽  
Acute Promyelocytic Leukemia ◽  
Research Funding ◽  
Safety Monitoring ◽  
Promyelocytic Leukemia ◽  
Rt Pcr ◽  
Monitoring Committee ◽  
Safety Monitoring Committee

Abstract Introduction: The role of maintenance treatment in patients with high-risk Acute Promyelocytic Leukemia (APL) in the era of ATO/ATRA is unclear. Methods: We retrospectively reviewed electronic medical records of patients with high-risk Acute Promyelocytic Leukemia (APL) and identified patients who did not receive maintenance. Results: We have identified 9 patients with high-risk APL who did not receive maintenance therapy. Five patients were females and 8 were white. The median age was 47-year-old (range 26-77 year old). The median WBC was 41,500 (range 14,700-167,500). The median blast percentage was 81% (range 1%-91%). The median platelet count was 28,000 (range 7,000-60,000). One patient received G-CSF prior to diagnosis of APL but the majority of cells on presentation were blasts. Two patients had additional cytogenetics changes apart from presence of t(15;17)(q22;21). Three patients had FLT3 ITD detected. All patients received ATRA during induction. Moreover, during induction 8 patients received Arsenic and all but one received Idarubicin. Seven of the 8 received Idarubicin according to Australasian APLM4 study. Bone marrow biopsies following induction were negative for PML/RARA by FISH analysis. RT-PCR for PML/ RARA was obtained at the time of the bone marrow (BM) biopsy in 8 patients and was negative. One patient had assessment close to the time of BM biopsy from peripheral blood and was negative. The median time from diagnosis to post Induction bone marrow was 49 days (range 32-56 days). All patients received 4 cycle of consolidation with ATRA and ATO according to Italian-German APL 0406 trial ( Lo-Coco et al., NEJM 2013). Three patients received Intrathecal chemotherapy for prophylaxis. Six of 9 had end-of-treatment bone marrow, which were negative for relapse. All patients were subsequently followed by RT-PCR for PML/RARA for molecular relapse. At last follow-up, all patients are alive and were in molecular remission. The median follow-up from diagnosis was 916 day (range 429-1674). Conclusion: We report our experience of high-risk APL patients in our institution who did not receive maintenance. None of the patients relapsed and our data suggest that patients that do not undergo maintenance in the era of ATO/Arsenic consolidation may remain in remission. Table. Table. Disclosures Erba: Takeda/Millenium: Research Funding; Pfizer: Consultancy, Other: grant; Celgene: Consultancy, Speakers Bureau; Novartis: Consultancy, Speakers Bureau; Takeda/Millenium: Research Funding; Pfizer: Consultancy, Other: grant; Incyte: Consultancy, Speakers Bureau; Amgen: Research Funding; Daiichi Sankyo: Consultancy, Research Funding; Astellas: Research Funding; Incyte: Consultancy, Speakers Bureau; Jazz: Consultancy, Speakers Bureau; Astellas: Research Funding; Seattle Genetics: Consultancy, Research Funding; Daiichi Sankyo: Consultancy, Research Funding; Amgen: Research Funding; Novartis: Consultancy, Speakers Bureau; Novartis: Consultancy, Speakers Bureau; Astellas: Research Funding; Agios: Consultancy, Speakers Bureau; Agios: Consultancy, Speakers Bureau; Glycomimetics: Consultancy, Other: Chair, Data and Safety Monitoring Committee; Novartis: Consultancy, Speakers Bureau; Amgen: Research Funding; Amgen: Research Funding; Glycomimetics: Consultancy, Other: Chair, Data and Safety Monitoring Committee; Astellas: Research Funding; Seattle Genetics: Consultancy, Research Funding; Janssen: Research Funding; Janssen: Research Funding; MacroGenics: Consultancy; MacroGenics: Consultancy; Pfizer: Consultancy, Other: grant; Juno: Research Funding; Juno: Research Funding; Pfizer: Consultancy, Other: grant; Agios: Consultancy, Speakers Bureau; Agios: Consultancy, Speakers Bureau; Seattle Genetics: Consultancy, Research Funding; Incyte: Consultancy, Speakers Bureau; Seattle Genetics: Consultancy, Research Funding; Incyte: Consultancy, Speakers Bureau; Jazz: Consultancy, Speakers Bureau; Takeda/Millenium: Research Funding; Immunogen: Consultancy, Research Funding; Jazz: Consultancy, Speakers Bureau; Takeda/Millenium: Research Funding; Celgene: Consultancy, Speakers Bureau; Immunogen: Consultancy, Research Funding; MacroGenics: Consultancy; Glycomimetics: Consultancy, Other: Chair, Data and Safety Monitoring Committee; MacroGenics: Consultancy; Celgene: Consultancy, Speakers Bureau; Juno: Research Funding; Daiichi Sankyo: Consultancy, Research Funding; Glycomimetics: Consultancy, Other: Chair, Data and Safety Monitoring Committee; Juno: Research Funding; Daiichi Sankyo: Consultancy, Research Funding; Immunogen: Consultancy, Research Funding; Jazz: Consultancy, Speakers Bureau; Celgene: Consultancy, Speakers Bureau; Immunogen: Consultancy, Research Funding. Papadantonakis:Agios pharmaceuticals: Honoraria, Other: advisory board.

ATRA is effective to an acute promyelocytic leukemia patient without RARA gene rearrangement

2010 ◽  
Vol 34 (8) ◽  
pp. e190-e193 ◽  
Author(s):  
Xianmin Song ◽  
Shenglan Gong ◽  
Jie Chen ◽  
Lei Gao ◽  
Jianmin Yang ◽  
...  
Keyword(s):  
Acute Promyelocytic Leukemia ◽  
Gene Rearrangement ◽  
Promyelocytic Leukemia ◽  
Acute Promyelocytic Leukemia Patient ◽  
Leukemia Patient
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