Blood Journal
Leading the way in experimental and clinical research in hematology

Treatment of newly diagnosed acute promyelocytic leukemia (APL): a comparison of French-Belgian-Swiss and PETHEMA results

  1. Lionel Adès1,
  2. Miguel A. Sanz2,
  3. Sylvie Chevret3,
  4. Pau Montesinos2,
  5. Patrice Chevallier4,
  6. Emmanuel Raffoux3,
  7. Edo Vellenga5,
  8. Agnès Guerci6,
  9. Arnaud Pigneux7,
  10. Francoise Huguet8,
  11. Consuelo Rayon9,
  12. Anne Marie Stoppa10,
  13. Javier de la Serna11,
  14. Jean-Yves Cahn12,
  15. Sandrine Meyer-Monard13,
  16. Thomas Pabst14,
  17. Xavier Thomas15,
  18. Stéphane de Botton16,
  19. Ricardo Parody17,
  20. Juan Bergua18,
  21. Thierry Lamy19,
  22. Anne Vekhoff20,
  23. Silvia Negri21,
  24. Norbert Ifrah22,
  25. Hervé Dombret3,
  26. Augustin Ferrant23,
  27. Dominique Bron24,
  28. Laurent Degos3, and
  29. Pierre Fenaux1
  1. 1Hôpital Avicenne, Université Paris 13, Paris, France;
  2. 2University Hospital La Fe, Valencia, Spain;
  3. 3Hôpital Saint Louis, Université Paris 7, Paris, France;
  4. 4Centre Hospitalier Universitaire (CHU) Nantes, Nantes, France;
  5. 5University Hospital Groningen, Hanzeplein, the Netherlands;
  6. 6CHU Nancy, Nancy, France;
  7. 7CHU de Bordeaux, Bordeaux, France;
  8. 8CHU de Toulouse, Toulouse, France;
  9. 9Hospital Central de Asturias, Oviedo, Spain;
  10. 10Institut Paoli Calmettes, Marseille, France;
  11. 11Hospital 12 de Octubre, Madrid, Spain;
  12. 12CHU Grenoble, Grenoble, France;
  13. 13Universitatsspital Basel, Basel, Switzerland;
  14. 14Universitatsspital Berne, Berne, Switzerland;
  15. 15CHU Lyon, Lyon, France;
  16. 16Institut gustave Roussy, Villejuif, France;
  17. 17Hospital Virgen del Rocío, Sevilla, Spain;
  18. 18Hospital San Pedro de Alcántara, Cáceres, Spain;
  19. 19CHU Rennes, Rennes, France;
  20. 20Hotel Dieu, Université Paris 5, Paris, France;
  21. 21Hospital Carlos Haya, Málaga, Spain;
  22. 22CHU Angers, Angers, France;
  23. 23Université Catholique de Louvain, Brussels, Belgium; and
  24. 24Institut Jules Bordet, Brussels, Belgium


All-trans retinoic acid (ATRA) plus anthracycline chemotherapy is the reference treatment of newly diagnosed acute promyelocytic leukemia (APL), whereas the role of cytosine arabinoside (AraC) remains disputed. We performed a joint analysis of patients younger than 65 years included in Programa para el Estudio de la Terapéutica en Hemopatía Maligna (PETHEMA) LPA 99 trial, where patients received no AraC in addition to ATRA, high cumulative dose idarubicin, and mitoxantrone, and APL 2000 trial, where patients received AraC in addition to ATRA and lower cumulative dose daunorubicin. In patients with white blood cell (WBC) count less than 10 × 109/L, complete remission (CR) rates were similar, but 3-year cumulative incidence of relapse (CIR) was significantly lower in LPA 99 trial: 4.2% versus 14.3% (P = .03), although 3-year survival was similar in both trials. This suggested that AraC is not required in APL with WBC count less than 10 × 109/L, at least in trials with high-dose anthracycline and maintenance treatment. In patients with WBC of 10 × 109/L or more, however, the CR rate (95.1% vs 83.6% P = .018) and 3-year survival (91.5% vs 80.8%, P = .026) were significantly higher in APL 2000 trial, and there was a trend for lower 3-year CIR (9.9% vs 18.5%, P = .12), suggesting a beneficial role for AraC in those patients.

  • Submitted July 9, 2007.
  • Accepted October 17, 2007.
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