Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Therapeutic research in untreated acute promyelocytic leukemia

Leukemia volume 19, pages 913–915 (2005)Cite this article

This commentary is motivated by Schlenk et al's1 interesting contribution to the discussion of two of the more debated issues in therapy of acute promyelocytic leukemia (APL): (1) the need for maintenance therapy, and (2) the possibility of improving therapy in high-risk patients. It is well known that use of all-trans retinoic acid (ATRA) together with anthracyclines, or mitoxantrone, ± ara-C produces long-term remissions in 90% of patients who present with WBC counts <10 000/μl, but only 60–70% of patients with initial WBC counts >10 000/μl; the latter patients accordingly are referred to as ‘high risk’. Given these results, it is natural to ask whether we can make therapy easier, at least for low-risk patients, for example, by shortening its duration or by eliminating chemotherapy altogether, and whether outcome in high-risk patients can be made similar to that in low-risk patients, in effect eliminating the prognostic significance of initial WBC count. Both questions lead to consideration of new therapeutic approaches, such as that employed by Schlenk et al on behalf of the German AMLSG1 and of statistical designs appropriate for a situation where the results are already quite good, as in, at least, low-risk APL.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it

$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

References

  1. Schlenk R, Germing U, Hartmann F, Glasmacher A, Fischer J, del Valle y Fuentes F, et al., for the AML Study Group. High dose cytarabine and mitoxantrone in consolidation therapy for acure promyelocytic leukemia. Leukemia 2005; 19: 978–983.

    Article  CAS  PubMed  Google Scholar 

  2. Fenauax P, Chastang C, Chevret S, Sanz M, Dombret H, Archimbaud E, et al., for the European APL Group. A randomized comparison of all trans-retinoic acid (ATRA) followed by chemotherapy and ATRA plus chemotherapy and the role of maintenance therapy in newly diagnosed acute promyelocytic leukemia. Blood 1999; 94: 1192–1200.

    Google Scholar 

  3. Avvisati G, Petti M, Lo-Coco F, Vegna M, Amadori S, Baccarani M, et al., for the GIMEMA Group. Induction therapy with idarubicin alone significantly influences event-free survival duration in patients with newly diagnosed hypergranular acute promyelocytic leukemia: final results of the GIMEMA randomized study LAP 0389 with 7 years of minimal follow-up. Blood 2002; 100: 3141–3146.

    Article  CAS  PubMed  Google Scholar 

  4. Sanz M, Lo Coco F, Martín G, Avvisati G, Rayón C, Barbui T, for the Spanish PETHEMA and Italian GIMEMA Copeartive Groups. Definition of relapse risk and role of nonanthracycline drugs for consolidation in patients with acute promyelocytic leukemia: a joint study of the PETHEMA and GIMEMA cooperative groups. Blood 2000; 96: 1247–1253.

    CAS  PubMed  Google Scholar 

  5. Lo Coco F, Diverio D, Avvisati G, Petti M, Meloni G, Pogliani E et al. Therapy of molecular relapse in acute promyelocytic leukemia. Blood 1999; 94: 2225–2229.

    CAS  PubMed  Google Scholar 

  6. Estey E . Treatment options for relapsed APL. Best Pract Res Clin Haematol 2003; 16: 521–534.

    Article  CAS  PubMed  Google Scholar 

  7. Mandelli F, Diverio D, Avvisati G, Luciano A, Barbui T, Bernasconi C, et al., for the GIMEMA and AEIOP Groups. Molecular remission in PML/RARα-positive acute promyelocytic leukemia by combined all-trans retinoic acid and idarubicin therapy. Blood 1997; 90: 1014–1021.

    CAS  PubMed  Google Scholar 

  8. Sanz M, 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 

  9. Soignet S, Frankel S, Douer D, Tallman M, Kantarjian H, Calleja E et al. United States multicenter study of arsenic trioxide in relapsed acute promyelocytic leukemia. J Clin Oncol 2001; 19: 3852–3860.

    Article  CAS  PubMed  Google Scholar 

  10. Jurcic J, DeBlasio T, Dumont L, Yao T, Scheinberg D . Molecular remission induction with retinoic acid and anti-CD33 monoclonal antibody HuM195 in acute promyelocytic leukemia. Clin Cancer Res 2000; 6: 372–380.

    CAS  PubMed  Google Scholar 

  11. Fenaux P, Castaigne S, Chomienne C, Dombret H, Degos L . All trans retinoic acid treatment for patients with acute promyelocytic leukemia. Leukemia 1992; 6 (Suppl 1): 64–66.

    PubMed  Google Scholar 

  12. Shen Z-X, Shi Z-Z, Fang J, Gu B-W, Li J-M, Zhu Y-M et al. All-trans retinoic acid/As2O3 combination yields a high quality remission and survival in newly diagnosed acute promyelocytic leukemia. Proc Natl Acad Sci USA 2004; 101: 5328–5335.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Ades L, Chevret S, De Botton S, Thomas X, Dombret H, Beve B, et al., for the European APL Group. Outcome of acute promyelocytic leukemia treated with all trans retinoic acid and chemotherapy in elderly patients: the European group experience. Leukemia 2005; 19: 230–233.

    Article  CAS  PubMed  Google Scholar 

  14. Sanz M, Vellenga E, Rayón C, Díaz-Mediavilla J, Rivas C, Amutio E et al. All-trans retinoic acid and anthracycline monochemotherapy for the treatment of elderly patients with acute promyelocytic leukemia. Blood 2004; 104: 3490–3493.

    Article  CAS  PubMed  Google Scholar 

  15. Estey E, Giles F, Beran M, O'Brien S, Pierce S, Faderl S et al. Experience with gemtuzumab ozogamycin (‘mylotarg’) and all-trans retinoic acid in untreated acute promyelocytic leukemia. Blood 2002; 99: 4222–4224.

    Article  CAS  PubMed  Google Scholar 

  16. Lo Coco F, Cimino G, Breccia M, Noguera N, Diverio D, Finolezzi E et al. Gemtuzumab ozogamicin (mylotarg) as a single agent for molecularly relapsed acute promyelocytic leukemia. Blood 2004; 104: 1995–1999.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

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

    E Estey

Authors
  1. E Estey
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E Estey.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Estey, E. Therapeutic research in untreated acute promyelocytic leukemia. Leukemia 19, 913–915 (2005). https://doi.org/10.1038/sj.leu.2403767

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.leu.2403767

This article is cited by

Search

Advanced search

Quick links