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Prophylactic intrathecal chemotherapy in acute promyelocytic leukemia (APL)

Leukemia volume 18, pages 879–880 (2004)Cite this article

TO THE EDITOR

Ohno et al1 have recently proposed their strategy for further increasing cure rates in acute promyelocytic leukemia (APL). As described by the authors, there is a common perception that extramedullary relapse including central nervous system (CNS) disease occurs more frequently in patients treated with all trans-retinoic acid (ATRA). In an analysis of patients enrolled into two consecutive studies by Gruppo Italiano Malattie Ematologiche dell' Adulto (GIMEMA), extramedullary leukemia occurred in 16 of 131 (12%) patients vs five of 94 (5%) patients treated with or without ATRA, respectively (P=0.08). The probabilities of extramedullary relapse were 4.5 and 3%, respectively (P=0.79), while the probabilities of CNS involvement were 0.6 and 2% (P=0.28).2 In the JALSG studies, none of the patients treated in the pre-ATRA era had extramedullary relapse as compared to 10 of 121 (8%) patients treated with ATRA-containing regimens (P=0.063).1 The incidence of CNS disease at relapse was also not significantly higher in the ATRA-treated patients (P=0.148).1

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  1. Department of Leukemia, University of Texas – MD Anderson Cancer Center, Houston, TX, USA

    F Ravandi

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Correspondence to F Ravandi.

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No further comments have been received from Dr Ohno

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Ravandi, F. Prophylactic intrathecal chemotherapy in acute promyelocytic leukemia (APL). Leukemia 18, 879–880 (2004). https://doi.org/10.1038/sj.leu.2403306

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