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Acute Leukemias

High dose ara-C in the treatment of newly diagnosed acute promyelocytic leukemia: long-term results of the German AMLCG

Leukemia volume 23, pages 2248–2258 (2009)Cite this article

Abstract

The objective of this study for newly diagnosed acute promyelocytic Leukemia (APL) was to evaluate the efficacy of an intensified double induction chemotherapy including high dose ara-C (HD) and all-trans retinoic acid (ATRA) followed by consolidation and 3 years maintenance therapy. In contrast to APL studies stratifying therapy according to pretreatment white blood cell (WBC) count < and ⩾10 × 109/l (low/intermediate and high risk according to the Sanz score), our patients received uniform therapy. From 1994 to 2005, 142 patients (age, 16–60 years) were enrolled. In the low/intermediate (n=105) vs high (n=37) WBC group, the rates of complete remission were 95.2 vs 83.8%, of induction death were 4.8 vs 16.2% (P=0.05) and of molecular remission were 87.5 vs 91.3% (P=1). Long-term overall survival was 84.4 vs 73.0% (P=0.12), event free survival was 78.3 vs 67.3% (P=0.11), relapse free survival was 82.1 vs 80.0% (P=0.83) and the cumulative incidence of relapse was 7.4 vs 11.4% (P=0.46). No relapse or death occurred after 4.7 years. ATRA and intensified chemotherapy including HD ara-C followed by prolonged maintenance therapy reduced the relapse risk in high risk patients. Pretreatment WBC count ⩾10 × 109/l count was no relevant prognostic factor for relapse.

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Acknowledgements

We are indebted to Prof Dr Wolfgang Köpcke (University of Münster, Germany) for his biostatistical advice.

The study was supported in part by Grant No. 01ZP8701 of German Federal Minister for Research and Technology.

Author information

Author notes

  1. E Lengfelder, C Haferlach, S Saussele, T Haferlach, B Schultheis, S Schnittger, W-D Ludwig, P Staib, C Aul, A Grüneisen, W Kern, A Reichle, H Serve, W E Berdel, J Braess, K Spiekermann, B Wörmann, M-C Sauerland, A Heinecke, W Hiddemann, R Hehlmann and T Büchner: A complete list of participating institutions appears in the Appendix.

Authors and Affiliations

  1. III. Medizinische Universitätsklinik Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany

    E Lengfelder, S Saussele, B Schultheis & R Hehlmann

  2. Münchner Leukämie Labor, München, Germany

    C Haferlach, T Haferlach, S Schnittger & W Kern

  3. Robert-Rössle Klinik, Humboldt Universität Berlin, Berlin, Germany

    W-D Ludwig

  4. Klinik I für Innere Medizin, Universität zu Köln, Köln, Germany

    P Staib

  5. Medizinische Klinik II, St-Johannes Hospital Duisburg, Duisburg, Germany

    C Aul

  6. II. Innere Abteilung, Klinikum Berlin-Neukölln, Berlin, Germany

    A Grüneisen

  7. Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, Regensburg, Germany

    A Reichle

  8. Medizinische Klinik und Poliklinik, Innere Medizin A, Universitätsklinikum Münster, Münster, Germany

    H Serve, W E Berdel & T Büchner

  9. Medizinische Klinik III, Klinikum Großhadern der Ludwig-Maximilians-Universität München, München, Germany

    J Braess, K Spiekermann & W Hiddemann

  10. Medizinische Klinik, Städtisches Klinikum Braunschweig, Braunschweig, Germany

    B Wörmann

  11. Institut für Medizinische Informatik und Biomathematik, Universität Münster, Münster, Germany

    M-C Sauerland & A Heinecke

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  1. E Lengfelder
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Consortia

for the German AML Cooperative Group (AMLCG)

Corresponding author

Correspondence to E Lengfelder.

Appendix

Appendix

The following institutions and clinicians participated in the study: University Hospital, Aachen (T Ittel); Municipal Hospital, Bad Saarow (H Fuß); Municipal Hospital Neukölln, Berlin (A Mayr, A Grüneisen); University Hospital Charité, Berlin (R Arnold, B Dörken, G Maschmeyer); University Hospital Benjamin Franklin, Berlin (M Notter, E Thiel); University Hospital Robert Rössle, Berlin (WD Ludwig, D Schöndube); Municipal Hospital, Bielefeld (AJ Weh, A Zumsprekel); Knappschaft Hospital, Bochum (C Teschendorf, M Stechstor); Knappschaft Hospital, Bottrop (G Trenn); Municipal Medical Center, Braunschweig (B Wörmann); Municipal Hospital St Jürgenstraße, Bremen (B Hertenstein, H Thomssen, A Peyn); St Johannes Hospital, Dortmund (H Pielken, H Hindahl); University Hospital, Düsseldorf (A Wehmeyer, A Heyll); Municipal Hospital, Düren (M Flaßhove, J Karow); St Johannes Hospital, Duisburg (C Aul, C Giagounidis); St Antonius Hospital, Eschweiler (R Fuchs, F Schlegel); Tumorklinik, Essen (S Seeber); St Joseph-Hospital, Gelsenkirchen (G Meckenstock, G Giagounidis); University Hospital, Göttingen (D Haase, L Trümper, F Griesinger); Municipal Hospital, Gütersloh (C Gropp, R Depenbusch); Municipal Hospital, Hagen (H Eimermacher); Municipal Hospital Martha-Maria, Halle (W Schütte, U Haak); General Hospital Altona, Hamburg (D Braumann); Evangelian Hospital, Hamm (L Balleisen); Municipal Hospital Hannover-Siloah, Hannover (H Kirchner); District Hospital, Herford (JG Lange, U Schmitz- Hübner); Municipal Hospital, Idar- Oberstein (A Fauser); University Hospital, Jena (H-J Fricke); Municipal Hospital, Kassel (M Wolf, B Ritter), University Hospital II, Kiel (M Kneba); University Hospital, Köln (M Hallek, P Staib); Municipal Hospital, Köln (A Dormann); Municipal Hospital, Krefeld (Th Frieling, M Planker); Hospital Lippe-Lemgo, Lemgo (F Hartmann, H Middeke, C Gründgens, C Constantin); Municipal Hospital, Leverkusen (N Niederle); University Hospital, Lübeck (Th Wagner); Municipal Hospital South Lübeck, Lübeck (S Fetscher, J Schmielau); Municipal Hospital, Ludwigshafen (M Uppenkamp, M Hoffmann); University Hospital, Mannheim (R Hehlmann, E Lengfelder); St Walburga Hospital, Meschede (M Schwonzen, H Spangenberg); Maria- Hilf- Hospital, Mönchengladbach (D Graeven, D Kohl, T Heuer); University Clinic Innenstadt, München (B Emmerich, R Dengler, B Schlag); University Hospital Großhadern, München (W Hiddemann); Municipal Hospital Neuperlach, München (K Nibler, D Fleckenstein); University Hospital, Münster (T Büchner, WE Berdel, H Serve); Municipal Hospital, Osnabrück (J Hartlapp, T Hegge, R Peceny); Paracelsus Hospital, Osnabrück (O Koch, G Innig); Municipal Medical Center, Passau (Th Südhoff, Th Wagner); University Hospital, Regensburg (A Reichle, R Andreesen); Municipal Hospital, Siegen (W Gassmann, T Gaska); Dr Horst Schmitt Hospital, Wiesbaden (N Frickhofen, H-G Fuhr); Heinrich Braun Hospital, Zwickau (U Kreibich, G Schott, S Sommer, W Zschille).

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Lengfelder, E., Haferlach, C., Saussele, S. et al. High dose ara-C in the treatment of newly diagnosed acute promyelocytic leukemia: long-term results of the German AMLCG. Leukemia 23, 2248–2258 (2009). https://doi.org/10.1038/leu.2009.183

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