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Response to Sanz et al

Leukemia volume 15, page 2002 (2001)Cite this article

In this discussion addressing diverse aspects of APL treatment, it should be kept in mind that the usefulness of a potent chemotherapy in addition to ATRA is suggested by the fact that cure cannot be achieved with ATRA alone. Therefore, it was the main aim of our treatment protocol to investigate the effects of ATRA combined with an intensive chemotherapy regimen with proven high antileukemic efficacy in APL (double induction including high-dose ara-C, consolidation and maintenance therapy).1 Intensive chemotherapy regimens are generally associated with treatment-related toxicity.

Dr Sanz and colleagues overstress the issue of toxicity and compliance in our trial. Our regimen of double induction using high-dose ara-C and ATRA resulted in spite of its intensity in only 8% early death and 4% death in remission1 as compared with 10% early death in the Spanish trial.2 Ninety-one percent of the responders in our study received consolidation and 71% of them received maintenance treatment.1 Omissions or premature terminations of treatment were no protocol violations and do not reflect poor compliance. Even with these treatment adaptations and an evaluation according to intent-to-treat the relapse rate is the lowest relapse rate after 3 years known from the literature.

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References

  1. Lengfelder E, Reichert A, Schoch C, Haase D, Haferlach T, Löffler H, Staib P, Heyll A, Seifarth W, Saussele S, Fonatsch Ch, Gassmann W, Ludwig WD, Hochhaus A, Beelen D, Aul C, Sauerland MC, Heinecke A, Hehlmann R, Wörmann B, Hiddemann W, Büchner T . Double induction strategy including high-dose cytarabine in combination with all-trans retinoic acid: effects in patients with newly diagnosed acute promyelocytic leukemia Leukemia 2000 14: 1362–1370

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  2. Sanz MA, Martín G, Rayón C, Esteve J, Gonzáles M, Díaz-Mediavilla J, Bolufer P, Barragán E, Terol MJ, Gónzales JD, Colomer D, Chillón C, Rivas C, Gómez C, Ribera JM, Bornstein R, Róman J, Calasanz MJ, Arias J, Álvarez C, Ramos F, Debén G for the PETHEMA Group . A modified AIDA protocol with anthracycline-based consolidation results in high antileukemic efficacy and reduced toxicity in newly diagnosed PML/RARa-positive acute promyelocytic leukemia Blood 1999 94: 3015–3021

    CAS  PubMed  Google Scholar 

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  1. III. Medizinische Klinik Mannheim, Weisbadener Strasse 7–11, Mannheim, 68305, Germany

    E Lengfelder, R Hehlmann & T Büchner

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  1. E Lengfelder
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  2. R Hehlmann
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  3. T Büchner
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Lengfelder, E., Hehlmann, R., Büchner, T. et al. Response to Sanz et al. Leukemia 15, 2002 (2001). https://doi.org/10.1038/sj.leu.2402300

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