Abstract | BACKGROUND: PATIENTS: Forty-two patients with confirmed APL (by t(15;17) and/or PML/RARA) treated at our institution (University hospital of Tunis) between January 1998 and June 2006 using two consecutive protocols: European APL93 trial (24 patients) until February 2004 and Spanish PETHEMA LPA99 trial (18 patients) more recently. Induction regimen consisted of ATRA 45 mg/m(2)/d until CR combined to DNR 60 mg/m(2)/d x 3+Cytarabine 200 mg/m(2)/d x 7 (APL93) and Idarubicin 12 mg/m(2) d2, 4, 6, 8 (LPA99). Prednisone (0.5 mg/kg d1-d15) was added if WBC >10 x 10(9)/L to prevent RAS in LPA 99. RESULTS: Median age was 36 yr (7-64 yr), M/F=16/26 (0.61), median WBC was 2.4 x 10(9)/L (range 0.6-100 x 10(9)/L). WBC >10 x 10(9)/L was noted in 14 patients (33%). Additional cytogenetic abnormalities were seen in 12/42 (28%). Median body mass index (BMI=weight/height(2):N 20-25) was 24 kg/m(2) (range 16-40 kg/m(2)), BMI >30 was noted in nine patients (8F and 1M). Thirty-three patients achieved CR (78.57%):18/24 (75%) in APL93 versus 15/18 (83%) in LPA99. Nine patients (21.42%) had early death. Causes of early death were: RAS (6) and CNS hemorrhage (3). Complications due to ATRA were: RAS (10), Scrotal ulcerations (3), Sweet syndrome (2), Perineal ulcerations (1), and Pseudotumor cerebri (1). Prognostic factors for complications of ATRA (Fisher exact test) were: BMI >35 (p=0.055), induction treatment without cytarabine (LPA99 trial) (p=0.047), whereas age (p=0.74), gender (p=0.51), initial WBC (p=0.47), and additional cytogenetic abnormalities (p=0.83) were not predictive. Retinoic Acid Syndrome was more reported in patients with initial WBC >10 x 10(9)/L (p=0.08). CONCLUSION: We found high BMI (>35) in female and treatment without Cytarabine to increase the risk of developing complications with ATRA.
|
Authors | Ramzi Jeddi, Karima Kacem, Hend Ben Neji, Samia Mnif, Emna Gouider, Lamia Aissaoui, Ramzi Ben Amor, Raihane Ben Lakhal, Hela Ben Abid, Zaher Belhadjali, Balkis Meddeb |
Journal | Hematology (Amsterdam, Netherlands)
(Hematology)
Vol. 13
Issue 3
Pg. 142-6
(Jun 2008)
ISSN: 1607-8454 [Electronic] England |
PMID | 18702871
(Publication Type: Journal Article)
|
Chemical References |
- Antineoplastic Agents
- Tretinoin
|
Topics |
- Adolescent
- Adult
- Antineoplastic Agents
(therapeutic use)
- Child
- Child, Preschool
- Female
- Humans
- Leukemia, Promyelocytic, Acute
(drug therapy, mortality)
- Male
- Middle Aged
- Predictive Value of Tests
- Survival Analysis
- Treatment Outcome
- Tretinoin
(therapeutic use, toxicity)
|