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Early death in acute promyelocytic leukemia (APL) in French centers: a multicenter study in 399 patients

Leukemia volume 28, pages 2422–2424 (2014)Cite this article

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In the past two decades, the combination of all-trans retinoic acid (ATRA) and anthracycline-based chemotherapy (CT) has improved the outcome of acute promyelocytic leukemia (APL) compared with CT alone. This has been achieved by reducing the incidence of relapse and increasing the complete remission (CR) rate, the latter through almost disappearance of cases of resistant leukemia and, in most studies, by reducing the frequency of early deaths.1, 2, 3, 4 In recent APL clinical trials, CR ranging from 90 to 95% have been reported, almost all failures resulting from early death (ED), mainly caused by bleeding, sepsis or differentiation syndrome (DS).5,6 Some recent studies have, however, reported ED rates as high as 15–30% in newly diagnosed APL when patients not included in clinical trials were analyzed together with protocol patients. In addition, when assessed in the United States SEER database,7 ED did not seem to have much improved between 1977 and 2007, in spite of the advent of ATRA treatment.

We retrospectively analyzed the incidence and causes of ED in APL in 17 French centers over a 5-year period (December 2006 to December 2011) included or not in APL 2006 trial, the only active French APL trial during that period. Diagnosis of APL was made on a morphological basis, and had to be confirmed by presence of t(15;17) translocation and/or promyelocytic leukemia gene-retinoic acid recepter alpha gene rearrangement. Every effort was made to collect all APL cases that presented during the 5-year period of analysis but was not included in APL 2006 by checking all APL diagnoses made in the hematology, cytogenetic and molecular laboratories of the institution, and by including patients admitted directly to the hospital intensive care unit (ICU) or to clinical departments of the hospital other than that of hematology to avoid any bias.

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Acknowledgements

Author contributions

XT, CR, NV, JD, ED, PH, DB, J-BM, AS, CM, CP, PB, J-PM, MH-B, NF, ER and HD provided the data. RR collected the data. LD, PF and LA designed the research. RR, PF and LA wrote the paper. LA analyzed the data.

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Authors and Affiliations

  1. Service d'Hématologie Senior, Hôpital Saint Louis, Université Paris 7, Paris, France

    R Rahmé, P Fenaux & L Adès

  2. Department of Hematology, Centre Hospitalier Lyon Sud, Lyon, France

    X Thomas

  3. Hematology, CHU Purpan, University of Toulouse, Toulouse, France

    C Recher

  4. Hematology Department, Institut Paoli Calmettes, Marseille, France

    N Vey

  5. Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France

    J Delaunay

  6. Hematology, CHU Besancon, Besancon, France

    E Deconinck

  7. Service d’Hématologie Clinique, Hôpital Saint-Antoine, AP-HP, Paris, France,

    P Hirsch

  8. CHU Limoges, Service d'Hématologie Clinique et Thérapie Cellulaire, Limoges, France

    D Bordessoule

  9. Hematology, Institut Gustave Roussy, Villejuif, France

    J-B Micol

  10. Hematology Department, Centre Henri Becquerel, Rouen, France

    A Stamatoullas

  11. Onco-Hematologie, CHU Grenoble, Grenoble, France

    C Mariette

  12. Hôpital Henri Mondor, AP-HP, Université Paris 12, Créteil, France

    C Pautas

  13. CHU Hautepierre, Université Strasbourg, Strasbourg, France

    P Bories

  14. Hematologie, Hopital Sud, CHU Amiens, Amiens, France

    J-P Marolleau

  15. CHU Angers, Angers, France

    M Hunault-Berger

  16. CHU Montpellier, Montpellier, France

    N Fegueux

  17. Hôpital Saint-Louis, AP-HP, Université Paris 7, Paris, France

    E Raffoux, H Dombret & L Degos

Authors
  1. R Rahmé
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  2. X Thomas
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  3. C Recher
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  4. N Vey
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  5. J Delaunay
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  8. D Bordessoule
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  9. J-B Micol
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  10. A Stamatoullas
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  11. C Mariette
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  12. C Pautas
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  13. P Bories
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  14. J-P Marolleau
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  15. M Hunault-Berger
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  16. N Fegueux
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  17. E Raffoux
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  18. H Dombret
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  19. L Degos
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  20. P Fenaux
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  21. L Adès
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Corresponding author

Correspondence to L Adès.

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Rahmé, R., Thomas, X., Recher, C. et al. Early death in acute promyelocytic leukemia (APL) in French centers: a multicenter study in 399 patients. Leukemia 28, 2422–2424 (2014). https://doi.org/10.1038/leu.2014.240

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