This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Specchia, G. Articles by Mandelli, F. Search for Related Content PubMed PubMed Citation Articles by Specchia, G. Articles by Mandelli, F. Social Bookmarking                            What's this?

Extramedullary Involvement at Relapse in Acute Promyelocytic Leukemia Patients Treated or Not With All-Trans Retinoic Acid: A Report by the Gruppo Italiano Malattie Ematologiche dell’Adulto

From the Department of Hematology, University of Bari, Bari; Dipartimento di Biotecnologie Cellulari ed Ematologia, Università "La Sapienza," and Ematologia, Università "Campus Bio-Medico," Rome; Divisione di Ematologia, Ospedale Ferrarotto, Catania; Divisione di Ematologia-Oncologia, Azienda Ospedale "Bianchi-Melacrino-Morelli," Reggio Calabria; and Divisione di Ematologia, Ospedale "A. Cardarelli," and Ematologia, "Università Federico II," Naples, Italy.

Address reprint requests to G. Specchia, MD, Department of Hematology, University of Bari, Policlinico, Piazza G. Cesare 11, 70124 Bari, Italy; email: emadhba{at}cimedoc.uniba.it

PURPOSE: Recent reports of extramedullary disease (EMD) at recurrence in acute promyelocytic leukemia (APL) have raised increasing concern about a possible role of retinoic acid (RA) therapy.

PATIENTS AND METHODS: We analyzed the risk of developing EMD localization at relapse in APL patients enrolled onto two consecutive studies of the Gruppo Italiano Malattie Ematologiche dell’Adulto. The studies investigated chemotherapy alone (LAP0389) versus RA plus chemotherapy (AIDA).

RESULTS: When all relapse types were taken into account, 94 (51%) of 184 patients and 131 (18%) of 740 patients who attained hematologic remission underwent relapse in the LAP0389 and AIDA studies, respectively (P < .0001). EMD localization was documented in five (5%) of 94 and 16 (12%) of 131 patients (P = .08). Hematologic and/or molecular relapse was diagnosed concomitantly in all but two patients with EMD in the AIDA study. For patients in the LAP0389 and AIDA series, the probability of EMD localization of any type at relapse was 3% and 4.5%, respectively (P = .79), while the probability of CNS involvement was 0.6% and 2% (P = .28). No significant differences were found with regard to mean WBC count and promyelocytic leukemia/retinoic acid receptor-alpha junction type in comparisons of patients with EMD and hematologic relapse.

CONCLUSION: APL patients receiving all-trans retinoic acid in addition to chemotherapy have no increased risk of developing EMD at relapse as compared with those treated with chemotherapy alone.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				P. Montesinos, J. Diaz-Mediavilla, G. Deben, V. Prates, M. Tormo, V. Rubio, I. Perez, I. Fernandez, M. Viguria, C. Rayon, et al. Central nervous system involvement at first relapse in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and anthracycline monochemotherapy without intrathecal prophylaxis Haematologica, September 1, 2009; 94(9): 1242 - 1249. [Abstract] [Full Text] [PDF]

				M. A. Sanz, D. Grimwade, M. S. Tallman, B. Lowenberg, P. Fenaux, E. H. Estey, T. Naoe, E. Lengfelder, T. Buchner, H. Dohner, et al. Management of acute promyelocytic leukemia: recommendations from an expert panel on behalf of the European LeukemiaNet Blood, February 26, 2009; 113(9): 1875 - 1891. [Abstract] [Full Text] [PDF]

				W.-Y. Au, S. Tam, B. M. Fong, and Y.-L. Kwong Determinants of cerebrospinal fluid arsenic concentration in patients with acute promyelocytic leukemia on oral arsenic trioxide therapy Blood, November 1, 2008; 112(9): 3587 - 3590. [Abstract] [Full Text] [PDF]

				S. Kesari, J. Drappatz, S. Akar, J.-A. Vergilio, P. Y. Wen, R. J. Soiffer, R. M. Stone, and D. J. DeAngelo Recurrent Acute Promyelocytic Leukemia Presenting As a Sacral Nerve Root Mass J. Clin. Oncol., July 1, 2008; 26(19): 3279 - 3281. [Full Text] [PDF]

				P Raanani, O Shpilberg, and I Ben-Bassat Extramedullary disease and targeted therapies for hematological malignancies--is the association real? Ann. Onc., January 1, 2007; 18(1): 7 - 12. [Abstract] [Full Text] [PDF]

				W.-Y. Au, S. Tam, B. M. Fong, and Y.-L. Kwong Elemental arsenic entered the cerebrospinal fluid during oral arsenic trioxide treatment of meningeal relapse of acute promyelocytic leukemia. Blood, April 1, 2006; 107(7): 3012 - 3013. [Full Text] [PDF]

				M. A. Sanz, M. S. Tallman, and F. Lo-Coco Practice Points, Consensus, and Controversial Issues in the Management of Patients with Newly Diagnosed Acute Promyelocytic Leukemia Oncologist, November 1, 2005; 10(10): 806 - 814. [Abstract] [Full Text] [PDF]

				J. J. Ortega, L. Madero, G. Martin, A. Verdeguer, P. Garcia, R. Parody, J. Fuster, A. Molines, A. Novo, G. Deben, et al. Treatment With All-Trans Retinoic Acid and Anthracycline Monochemotherapy for Children With Acute Promyelocytic Leukemia: A Multicenter Study by the PETHEMA Group J. Clin. Oncol., October 20, 2005; 23(30): 7632 - 7640. [Abstract] [Full Text] [PDF]

				B. Lowenberg, J. D. Griffin, and M. S. Tallman Acute Myeloid Leukemia and Acute Promyelocytic Leukemia Hematology, January 1, 2003; 2003(1): 82 - 101. [Abstract] [Full Text] [PDF]