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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
- Source :
- HAEMATOLOGICA, r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau, instname, r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe, Haematologica, 94(9), 1242-1249. Ferrata Storti Foundation
- Publication Year :
- 2009
- Publisher :
- FERRATA STORTI FOUNDATION, 2009.
-
Abstract
- 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.
- Subjects :
- 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]
idarubicin
Gastroenterology
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 Neoplasms
Leukemia, Promyelocytic, Acute
Recurrence
Risk Factors
Cumulative incidence
Antibiotics, Antineoplastic
Hematology
Middle Aged
all-trans retinoic acid
Leukemia
medicine.anatomical_structure
Named Groups::Persons::Age Groups::Adolescent [Medical Subject Headings]
Female
medicine.drug
Acute promyelocytic leukemia
Adult
central nervous system relapse
medicine.medical_specialty
Diseases::Neoplasms::Neoplasms by Histologic Type::Leukemia::Leukemia, Myeloid::Leukemia, Myeloid, Acute [Medical Subject Headings]
Anthracycline
Adolescent
Central nervous system
Check Tags::Male [Medical Subject Headings]
Tretinoin
Neoplasias del sistema nervioso central
Central nervous system disease
Internal medicine
Named Groups::Persons::Age Groups::Adult [Medical Subject Headings]
medicine
Idarubicin
Humans
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 aguda
Aged
Antibióticos antineoplásicos
business.industry
prognostic factors
Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Antineoplastic Agents::Antibiotics, Antineoplastic [Medical Subject Headings]
acute promyelocytic leukemia
medicine.disease
Surgery
Diseases::Neoplasms::Neoplasms by Site::Nervous System Neoplasms::Central Nervous System Neoplasms [Medical Subject Headings]
Check Tags::Female [Medical Subject Headings]
business
Subjects
Details
- ISSN :
- 03906078
- Database :
- OpenAIRE
- Journal :
- HAEMATOLOGICA, r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau, instname, r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe, Haematologica, 94(9), 1242-1249. Ferrata Storti Foundation
- Accession number :
- edsair.doi.dedup.....e760201757fc93e26f7103c82148364d