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Acute myeloid leukemia

Characteristics and outcome of patients with therapy-related acute promyelocytic leukemia front-line treated with or without arsenic trioxide

Leukemia volume 31, pages 2347–2354 (2017)Cite this article

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Abstract

Therapy-related acute promyelocytic leukemia (t-APL) is relatively rare, with limited data on outcome after treatment with arsenic trioxide (ATO) compared to standard intensive chemotherapy (CTX). We evaluated 103 adult t-APL patients undergoing treatment with all-trans retinoic acid (ATRA) alone (n=7) or in combination with ATO (n=24), CTX (n=53), or both (n=19). Complete remissions were achieved after induction therapy in 57% with ATRA, 100% with ATO/ATRA, 78% with CTX/ATRA, and 95% with CTX/ATO/ATRA. Early death rates were 43% for ATRA, 0% for ATO/ATRA, 12% for CTX/ATRA and 5% for CTX/ATO/ATRA. Three patients relapsed, two developed therapy-related acute myeloid leukemia and 13 died in remission including seven patients with recurrence of the prior malignancy. Median follow-up for survival was 3.7 years. None of the patients treated with ATRA alone survived beyond one year. Event-free survival was significantly higher after ATO-based therapy (95%, 95% CI, 82–99%) as compared to CTX/ATRA (78%, 95% CI, 64–87%; P=0.042), if deaths due to recurrence of the prior malignancy were censored. The estimated 2-year overall survival in intensively treated patients was 88% (95% CI, 80–93%) without difference according to treatment (P=0.47). ATO when added to ATRA or CTX/ATRA is feasible and leads to better outcomes as compared to CTX/ATRA in t-APL.

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References

  1. Lo-Coco F, Hasan SK, Montesinos P, Sanz MA . Biology and management of therapy-related acute promyelocytic leukemia. Curr Opin Oncol 2013; 25: 695–700.

    Article  CAS  PubMed  Google Scholar 

  2. Beaumont M, Sanz M, Carli PM, Maloisel F, Thomas X, Detourmignies L et al. Therapy-related acute promyelocytic leukemia. J Clin Oncol 2003; 21: 2123–2137.

    Article  CAS  PubMed  Google Scholar 

  3. Jantunen E, Heinonen K, Mahlamäki E, Penttilä K, Kuittinen T, Lehtonen P et al. Secondary acute promyelocytic leukemia: an increasingly common entity. Leuk Lymphoma 2007; 48: 190–191.

    Article  CAS  PubMed  Google Scholar 

  4. Mistry AR, Felix CA, Whitmarsh RJ, Mason A, Reiter A, Cassinat B et al. DNA topoisomerase II in therapy-related acute promyelocytic leukemia. N Engl J Med 2005; 352: 1529–1538.

    Article  CAS  PubMed  Google Scholar 

  5. Braun T, Cereja S, Chevret S, Raffoux E, Beaumont M, Detourmignies L et al. Evolving characteristics and outcome of secondary acute promyelocytic leukemia (APL): A prospective analysis by the French-Belgian-Swiss APL group. Cancer 2015; 121: 2393–2399.

    Article  CAS  PubMed  Google Scholar 

  6. Elliott MA, Letendre L, Tefferi A, Hogan WJ, Hook C, Kaufmann SH et al. Therapy-related acute promyelocytic leukemia: observations relating to APL pathogenesis and therapy. Eur J Haematol 2012; 88: 237–243.

    Article  CAS  PubMed  Google Scholar 

  7. Pulsoni A, Pagano L, Lo-Coco F, Avvisati G, Mele L, Di Bona E et al. Clinicobiological features and outcome of acute promyelocytic leukemia occurring as a second tumor: the GIMEMA experience. Blood 2002; 100: 1972–1976.

    Article  CAS  PubMed  Google Scholar 

  8. Kayser S, Döhner K, Krauter J, Köhne CH, Horst HA, Held G et al. The impact of therapy-related acute myeloid leukemia (AML) on outcome in 2853 adult patients with newly diagnosed AML. Blood 2011; 117: 2137–2145.

    Article  CAS  PubMed  Google Scholar 

  9. Gale RP, Bennett JM, Hoffman FO . Therapy-related AML: a slip of the lip can sink a ship. Leuk Res 2014; 38: 418–420.

    Article  PubMed  Google Scholar 

  10. Takahashi K, Wang F, Kantarjian H, Doss D, Khanna K, Thompson E et al. Preleukaemic clonal haemopoiesis and risk of therapy-related myeloid neoplasms: a case-control study. Lancet Oncol 2017; 18: 100–111.

    Article  PubMed  Google Scholar 

  11. Gillis NK, Ball M, Zhang Q, Ma Z, Zhao Y, Yoder SJ et al. Clonal haemopoiesis and therapy-related myeloid malignancies in elderly patients: a proof-of-concept, case-control study. Lancet Oncol 2017; 18: 112–121.

    Article  PubMed  Google Scholar 

  12. Hasan SK, Ottone T, Schlenk RF, Xiao Y, Wiemels JL, Mitra ME et al. Analysis of t(15;17) chromosomal breakpoint sequences in therapy-related versus de novo acute promyelocytic leukemia: association of DNA breaks with specific DNA motifs at PML and RARA loci. Genes Chromosomes Cancer 2010; 49: 726–732.

    Article  CAS  PubMed  Google Scholar 

  13. Mays AN, Osheroff N, Xiao Y, Wiemels JL, Felix CA, Byl JA et al. Evidence for direct involvement of epirubicin in the formation of chromosomal translocations in t(15;17) therapy-related acute promyelocytic leukemia. Blood 2010; 115: 326–330.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Huang ME, Ye YC, Chen SR, Chai JR, Lu JX, Zhoa L et al. Use of all‐trans retinoic acid in the treatment of acute promyelocytic leukemia. Blood 1988; 72: 567‐572.

    CAS  PubMed  Google Scholar 

  15. Ablain J, de The H . Revisiting the differentiation paradigm in acute promyelocytic leukemia. Blood 2011; 117: 5795–5802.

    Article  CAS  PubMed  Google Scholar 

  16. Castaigne S, Chomienne C, Daniel MT, Ballerini P, Berger R, Fenaux P et al. All‐trans retinoic acid as a differentiation therapy for acute promyelocytic leukemia. I. Clinical results. Blood 1990; 76: 1704‐1709.

    CAS  PubMed  Google Scholar 

  17. Chen ZX, Xue YQ, Zhang R, Tao RF, Xia XM, Li C et al. A clinical and experimental study on all‐trans retinoic acid‐treated acute promyelocytic leukemia patients. Blood 1991; 78: 1413‐1419.

    CAS  PubMed  Google Scholar 

  18. Chomienne C, Ballerini P, Balitrand N, Daniel MT, Fenaux P, Castaigne S et al. All-trans retinoic acid in acute promyelocytic leukemias. II. In vitro studies: structure-function relationship. Blood 1990; 76: 1710‐1717.

    CAS  PubMed  Google Scholar 

  19. Degos L, Chomienne C, Daniel MT, Berger R, Dombret H, Fenaux P et al. Treatment of first relapse in acute promyelocytic leukaemia with all-trans retinoic acid. Lancet 1990; 336: 1440‐1441.

    Article  CAS  PubMed  Google Scholar 

  20. Warrell RP, Frankel SR, Miller WH, Scheinberg DA, Itri LM, Hittelman WN et al. Differentiation therapy of acute promyelocytic leukemia with tretinoin (all-trans-retinoic acid). N Engl J Med 1991; 324: 1385‐1393.

    Article  PubMed  Google Scholar 

  21. Coombs CC, Tavakkoli M, Tallman MS . Acute promyelocytic leukemia: where did we start, where are we now, and the future. Blood Cancer J 2015; 5: e304.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Estey E, Garcia-Manero G, Ferrajoli A, Faderl S, Verstovsek S, Jones D et al. Use of all-trans retinoic acid plus arsenic trioxide as an alternative to chemotherapy in untreated acute promyelocytic leukemia. Blood 2006; 107: 3469–3473.

    Article  CAS  PubMed  Google Scholar 

  23. Lo-Coco F, Avvisati G, Vignetti M, Thiede C, Orlando SM, Iacobelli S et al. Retinoic acid and arsenic trioxide for acute promyelocytic leukemia. N Engl J Med 2013; 369: 111–121.

    Article  CAS  PubMed  Google Scholar 

  24. Burnett AK, Russell NH, Hills RK, Bowen D, Kell J, Knapper S et al. Arsenic trioxide and all-trans retinoic acid treatment for acute promyelocytic leukaemia in all risk groups (AML17): results of a randomised, controlled, phase 3 trial. Lancet Oncol 2015; 16: 1295–1305.

    Article  CAS  PubMed  Google Scholar 

  25. Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DA, Gralnick HR et al. Proposed revised criteria for the classification of acute myeloid leukemia. A report of the French-American-British Cooperative Group. Ann Intern Med 1985; 103: 620–625.

    Article  CAS  PubMed  Google Scholar 

  26. Cheson BD, Bennett JM, Kopecky KJ, Büchner T, Willman CL, Estey EH et al. Revised recommendations of the International Working Group for Diagnosis, Standardization of Response Criteria, Treatment Outcomes, and Reporting Standards for Therapeutic Trials in Acute Myeloid Leukemia. J Clin Oncol 2003; 21: 4642–4649.

    Article  PubMed  Google Scholar 

  27. Mitelman F . ISCN: An International System for Human Cytogenetic Nomenclature. S Karger: Basel, Switzerland, 1995.

    Google Scholar 

  28. Yokota S, Kiyoi H, Nakao M, Iwai T, Misawa S, Okuda T et al. Internal tandem duplication of the FLT3 gene is preferentially seen in acute myeloid leukemia and myelodysplastic syndrome among various hematological malignancies. A study on a large series of patients and cell lines. Leukemia 1997; 11: 1605–1609.

    Article  CAS  PubMed  Google Scholar 

  29. Thiede C, Steudel C, Mohr B, Schaich M, Schäkel U, Platzbecker U et al. Analysis of FLT3-activating mutations in 979 patients with acute myelogenous leukemia: association with FAB subtypes and identification of subgroups with poor prognosis. Blood 2002; 99: 4326–4335.

    Article  CAS  PubMed  Google Scholar 

  30. Mandelli F, Diverio D, Avvisati G, Luciano A, Barbui T, Bernasconi C et al. Molecular remission in PML/RAR alpha-positive acute promyelocytic leukemia by combined all-trans retinoic acid and idarubicin (AIDA) therapy. Gruppo Italiano-Malattie Ematologiche Maligne dell'Adulto and Associazione Italiana di Ematologia ed Oncologia Pediatrica Cooperative Groups. Blood 1997; 90: 1014–1021.

    CAS  PubMed  Google Scholar 

  31. Sanz MA, Martín G, González M, León A, Rayón C, Rivas C et al. Risk-adapted treatment of acute promyelocytic leukemia with all-trans-retinoic acid and anthracycline monochemotherapy: a multicenter study by the PETHEMA group. Blood 2004; 103: 1237–1243.

    Article  CAS  PubMed  Google Scholar 

  32. Sanz MA, Montesinos P, Rayón C, Holowiecka A, de la Serna J, Milone G et al. Risk-adapted treatment of acute promyelocytic leukemia based on all-trans retinoic acid and anthracycline with addition of cytarabine in consolidation therapy for high-risk patients: further improvements in treatment outcome. Blood 2010; 115: 5137–5146.

    Article  CAS  PubMed  Google Scholar 

  33. Burnett AK, Hills RK, Grimwade D, Jovanovic JV, Craig J, McMullin MF et al. Inclusion of chemotherapy in addition to anthracycline in the treatment of acute promyelocytic leukaemia does not improve outcomes: results of the MRC AML15 trial. Leukemia 2013; 27: 843–851.

    Article  CAS  PubMed  Google Scholar 

  34. Gore SD, Gojo I, Sekeres MA, Morris L, Devetten M, Jamieson K et al. Single cycle of arsenic trioxide-based consolidation chemotherapy spares anthracycline exposure in the primary management of acute promyelocytic leukemia. J Clin Oncol 2010; 28: 1047–1053.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Schemper M, Smith TL . A note on quantifying follow-up in studies of failure time. Control Clin Trials 1996; 17: 343–346.

    Article  CAS  PubMed  Google Scholar 

  36. Kaplan E, Meier P . Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457–481.

    Article  Google Scholar 

  37. Cox DR . Regression models and life tables (with discussion). J R Stat Soc 1972; 34: 187–220.

    Google Scholar 

  38. R Development Core Team R: A language and environment for statistical computing. R Foundation for Statistical Computing: Vienna, Austria, 2014.

  39. Duffield AS, Aoki J, Levis M, Cowan K, Gocke CD, Burns KH et al. Clinical and pathologic features of secondary acute promyelocytic leukemia. Am J Clin Pathol 2012; 137: 395–402.

    Article  PubMed  Google Scholar 

  40. Dayyani F, Kantarjian H, O’Brien S, Pierce S, Jones D, Faderl S et al. Outcome of therapy-related acute promyelocytic leukemia with or without arsenic trioxide as a component of frontline therapy. Cancer 2011; 117: 110–115.

    Article  CAS  PubMed  Google Scholar 

  41. Kiyoi H, Naoe T, Yokota S, Nakao M, Minami S, Kuriyama K et al. Internal tandem duplication of FLT3 associated with leukocytosis in acute promyelocytic leukemia. Leukemia Study Group of the Ministry of Health and Welfare (Kohseisho). Leukemia 1997; 11: 1447–1452.

    Article  CAS  PubMed  Google Scholar 

  42. Noguera NI, Breccia M, Divona M, Diverio D, Costa V, De Santis S et al. Alterations of the FLT3 gene in acute promyelocytic leukemia: association with diagnostic characteristics and analysis of clinical outcome in patients treated with the Italian AIDA protocol. Leukemia 2002; 16: 2185–2189.

    Article  CAS  PubMed  Google Scholar 

  43. Shih LY, Kuo MC, Liang DC, Huang CF, Lin TL, Wu JH et al. Internal tandem duplication and Asp835 mutations of the FMS-like tyrosine kinase 3 (FLT3) gene in acute promyelocytic leukemia. Cancer 2003; 98: 1206–1216.

    Article  CAS  PubMed  Google Scholar 

  44. Schlenk RF, Germing U, Hartmann F, Glasmacher A, Fischer JT, del Valle y Fuentes F et al. High-dose cytarabine and mitoxantrone in consolidation therapy for acute promyelocytic leukemia. Leukemia 2005; 19: 978–983.

    Article  CAS  PubMed  Google Scholar 

  45. De Botton S, Chevret S, Sanz M, Dombret H, Thomas X, Guerci A et al. Additional chromosomal abnormalities in patients with acute promyelocytic leukaemia (APL) do not confer poor prognosis: results of APL 93 trial. Br J Haematol 2000; 111: 801–806.

    CAS  PubMed  Google Scholar 

  46. Lou Y, Suo S, Tong H, Ye X, Wang Y, Chen Z et al. Characteristics and prognosis analysis of additional chromosome abnormalities in newly diagnosed acute promyelocytic leukemia treated with arsenic trioxide as the front-line therapy. Leuk Res 2013; 37: 1451–1456.

    Article  CAS  PubMed  Google Scholar 

  47. Cervera J, Montesinos P, Hernández-Rivas JM, Calasanz MJ, Aventín A, Ferro MT et al. Additional chromosome abnormalities in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and chemotherapy. Haematologica 2010; 95: 424–431.

    Article  CAS  PubMed  Google Scholar 

  48. Pantic M, Novak A, Marisavljevic D, Djordjevic V, Elezovic I, Vidovic A et al. Additional chromosome aberrations in acute promyelocytic leukemia: characteristics and prognostic influence. Med Oncol 2000; 17: 307–313.

    Article  CAS  PubMed  Google Scholar 

  49. Poiré X, Moser BK, Gallagher RE, Laumann K, Bloomfield CD, Powell BL et al. Arsenic trioxide in front-line therapy of acute promyelocytic leukemia (C9710): prognostic significance of FLT3 mutations and complex karyotype. Leuk Lymphoma 2014; 55: 1523–1532.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Cicconi L, Divona M, Ciardi C, Ottone T, Ferrantini A, Lavorgna S et al. PML-RARα kinetics and impact of FLT3-ITD mutations in newly diagnosed acute promyelocytic leukaemia treated with ATRA and ATO or ATRA and chemotherapy. Leukemia 2016; 30: 1987–1992.

    Article  CAS  PubMed  Google Scholar 

  51. Ottone T, Cicconi L, Hasan SK, Lavorgna S, Divona M, Voso MT et al. Comparative molecular analysis of therapy-related and de novo acute promyelocytic leukemia. Leuk Res 2012; 36: 474–478.

    Article  CAS  PubMed  Google Scholar 

  52. Yin CC, Glassman AB, Lin P, Valbuena JR, Jones D, Luthra R et al. Morphologic, cytogenetic, and molecular abnormalities in therapy-related acute promyelocytic leukemia. Am J Clin Pathol 2005; 123: 840–848.

    Article  PubMed  Google Scholar 

  53. Madan V, Shyamsunder P, Han L, Mayakonda A, Nagata Y, Sundaresan J et al. Comprehensive mutational analysis of primary and relapse acute promyelocytic leukemia. Leukemia 2016; 30: 1672–1681.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Platzbecker U, Avvisati G, Cicconi L, Thiede C, Paoloni F, Vignetti M et al. Improved outcomes with retinoic acid and arsenic trioxide compared with retinoic acid and chemotherapy in non-high-risk acute promyelocytic leukemia: final results of the randomized Italian-German APL0406 trial. J Clin Oncol 2016; 35: 605–612.

    Article  PubMed  Google Scholar 

  55. Abaza Y, Kantarjian HM, Garcia-Manero G, Estey E, Borthakur G, Jabbour E et al. Long-term outcome of acute promyelocytic leukemia treated with all-trans-retinoic acid, arsenic trioxide, and gemtuzumab. Blood 2016; 129: 1275–1283.

    Article  PubMed  Google Scholar 

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Acknowledgements

SK gratefully acknowledges to be supported by the Olympia-Morata fellowship program from the Medical Faculty of the Heidelberg University. MJL is supported by a grant from the NCI (NCI Leukemia SPORE P50 CA100632). RBW is a Leukemia & Lymphoma Society Scholar in Clinical Research. ZR, JM, JN, PZ and TS were supported by the Ministry of the Czech Republic, grant No. 15-25809A. UP was supported by a grant from the Deutsche Forschungsgemeinschaft (DFG SFB-655).

Author contributions

SK and UP were responsible for the concept of this paper, contributed to the literature search data collection, analyzed and interpreted data, and wrote the manuscript. AB, JK and RFS analyzed and interpreted data and critically revised the manuscript. DG performed research. CT performed research and critically revised the manuscript. MAE, KN, PG, RKH, MRB, ZR, JM, JN, PZ, TS, NHR, RBW, EHE, JW, MG, AK, BDS, AKB, CR, ADH, GE, MT and MJL contributed patients and critically revised the manuscript. All authors reviewed and approved the final manuscript.

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Author notes

  1. D Grimwade: Deceased.

Authors and Affiliations

  1. Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany

    S Kayser, A Krämer & A D Ho

  2. Department of Internal Medicine V, Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany

    S Kayser & A Krämer

  3. Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany

    J Krzykalla & A Benner

  4. Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA

    M A Elliott

  5. Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA

    K Norsworthy, B D Smith & M J Levis

  6. Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA

    P Gonzales & M S Tallman

  7. Cardiff University School of Medicine, Cardiff, UK

    R K Hills

  8. University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA

    M R Baer

  9. Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

    M R Baer

  10. Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic

    Z Ráčil & J Mayer

  11. Department of Internal Medicine and Haematology, 3rd Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic

    J Novak

  12. 4th Department of Internal Medicine-Hematology, Faculty of Medicine, Charles University and University Hospital Hradec Králové, Hradec Králové, Czech Republic

    P Žák

  13. Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic

    T Szotkowski

  14. Department of Medical & Molecular Genetics, Faculty of Life Sciences and Medicine, King’s College London, London, UK

    D Grimwade

  15. Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK

    N H Russell & A K Burnett

  16. Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    R B Walter & E H Estey

  17. Division of Hematology/Department of Medicine, University of Washington, Seattle, WA, USA

    R B Walter & E H Estey

  18. Department of Epidemiology, University of Washington, Seattle, WA, USA

    R B Walter

  19. Department of Hematology, Oncology and Tumor Immunology, Charité-University Medical Center, Campus Virchow Clinic, Berlin, Germany

    J Westermann

  20. Klinik für Hämatologie, Onkologie und Palliativmedizin, Klinikum Bielefeld Mitte, Bielefeld, Germany

    M Görner

  21. Department of Internal Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany

    C Thiede, C Röllig, G Ehninger & U Platzbecker

  22. National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany

    R F Schlenk

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Correspondence to S Kayser.

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Competing interests

SK was supported by the Olympia-Morata program from the Medical Faculty of the Heidelberg University. UP has received research support from TEVA. CT is part owner of AgenDix GmbH. All other authors declare no competing conflict of interest.

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Presented in part at the 21st Annual Meeting of the European Hematology Association in Copenhagen, Denmark, 10 June 2016.

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Kayser, S., Krzykalla, J., Elliott, M. et al. Characteristics and outcome of patients with therapy-related acute promyelocytic leukemia front-line treated with or without arsenic trioxide. Leukemia 31, 2347–2354 (2017). https://doi.org/10.1038/leu.2017.92

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