Improving acute promyelocytic leukemia (APL) outcome in developing countries through networking, results of the International Consortium on APL

Eduardo M. Rego, Haesook T. Kim, Guillermo J.. Ruiz-Argüelles, Maria Soledad Undurraga, Maria del Rosario Uriarte, Rafael H. Jacomo, Homero Gutiérrez-Aguirre, Raul A. M. Melo, Rosane Bittencourt, Ricardo Pasquini, Katia Pagnano, Evandro M. Fagundes, Maria de Lourdes Chauffaille, Carlos S. Chiattone, Lem Martinez, Luis A. Meillón, David Gómez-Almaguer, Hau C. Kwaan, Javier Garcés-Eisele, Robert Gallagher, Charlotte M. Niemeyer, Stanley L. Schrier, Martin Tallman, David Grimwade, Arnold Ganser, Nancy Berliner, Raul C. Ribeiro, Francesco Lo-Coco, Bob Löwenberg and Miguel A. Sanz

Key points

  • Development of a network was able to reduce significantly the early mortality and to improve the OS of APL patients in developing countries


Modern treatment with all-trans retinoic acid (ATRA) and chemotherapy has converted acute promyelocytic leukemia (APL) into the most frequently curable leukemia. However, this progress has not yielded equivalent benefit to developing countries. The IC-APL was established to create a network in developing countries that would exchange experience and data and receive support from well-established US and European cooperative groups. The IC-APL formulated expeditious diagnostic, treatment and supportive guidelines that were adapted to local circumstances. APL was elected as a model disease because of the potential impact of improved diagnosis and treatment. The project included 4 national coordinators and reference laboratories, common clinical record forms, 5 subcommittees, laboratory and data management training programs, with regular virtual and face-to-face meetings. Complete hematological remission was achieved by 153/180 (85%) patients and 27 (15%) died during induction. After a median follow up of 28 months, the 2-year cumulative incidence of relapse (CIR), overall survival (OS) and disease-free survival (DFS) were 4.5%, 80% and 91%, respectively. The establishment of the IC-APL network resulted in a nearly 50% decrease in early mortality and a nearly 30% improvement in OS compared to historical controls, resulting in OS and DFS similar to those reported in developed countries.

  • Submitted August 23, 2012.
  • Accepted November 27, 2012.