1. Improving acute promyelocytic leukemia (APL) outcome in developing countries through networking, results of the International Consortium on APL.
- Author
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Rego EM, Kim HT, Ruiz-Argüelles GJ, Undurraga MS, Uriarte Mdel R, Jacomo RH, Gutiérrez-Aguirre H, Melo RA, Bittencourt R, Pasquini R, Pagnano K, Fagundes EM, Chauffaille Mde L, Chiattone CS, Martinez L, Meillón LA, Gómez-Almaguer D, Kwaan HC, Garcés-Eisele J, Gallagher R, Niemeyer CM, Schrier SL, Tallman M, Grimwade D, Ganser A, Berliner N, Ribeiro RC, Lo-Coco F, Löwenberg B, and Sanz MA
- Subjects
- Adolescent, Adult, Aged, Brazil epidemiology, Chile epidemiology, Consensus, Disease-Free Survival, Female, Humans, Internationality, Leukemia, Promyelocytic, Acute mortality, Male, Mexico epidemiology, Middle Aged, Prognosis, Survival Analysis, Treatment Outcome, Uruguay epidemiology, Young Adult, Community Networks organization & administration, Developing Countries statistics & numerical data, Leukemia, Promyelocytic, Acute diagnosis, Leukemia, Promyelocytic, Acute therapy, Quality Improvement organization & administration
- 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.
- Published
- 2013
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