AML-103 Clinical Outcomes of Patients With High-Risk Acute Promyelocytic Leukemia (APL) Treated With All-Trans Retinoic Acid (ATRA)/Arsenic Trioxide (ATO)–Based Induction and Consolidation Without Maintenance Therapy: A Single-Institution Study

• Published in: Clinical lymphoma, myeloma and leukemia Vol. 23; p. S269
• Main Authors: Yohannan, Binoy, Sharma, Akanksha, Sridhar, Arthi, Cervoni-Curet, Frances, Rios, Adan
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.09.2023
• Subjects: AML; ATO; ATRA; high-risk APL; AML; high-risk APL; ATRA; ATO; case
• ISSN: 2152-2650; 2152-2669
• DOI: 10.1016/S2152-2650(23)00995-3

Patients with high-risk APL have a worse event-free survival than low-risk APL patients. Maintenance therapy improves disease-free survival in high-risk APL patients treated with ATRA plus chemotherapy as induction and consolidation therapy. The role of maintenance therapy in patients treated with a chemotherapy-free regimen of ATRA plus ATO is controversial. Analyze outcomes of high-risk APL patients treated without maintenance therapy at our institution. Retrospective study of patients with high-risk APL treated between January 1, 2014, and December 31, 2021, at Memorial Hermann Hospital, Texas Medical Center. General community, academic hospital. Patients (>18 years old) with high-risk APL. Rate of complete response (CR) and long-term survival. We identified 12 patients with high-risk APL. The median age was 35.5 (range, 20–67) years; 7 (58%) were women. Subject races included: white (n=7), African American (n=2), Asian (n=1), and Hispanic (n=2). The median white blood cell count was 32K/μL, and the median bone marrow (BM) blast count was 80%. All 12 patients received ATRA+ATO for induction: 9 patients received idarubicin, 1 received daunorubicin, and 2 received gemtuzumab ozogamicin. In addition, 2 patients received hydroxyurea and cytarabine for cytoreduction. Median time from diagnosis to post-induction BM biopsy was 25 (range, 22–31) days. All 12 patients achieved CR after induction, and all patients had a positive PML-RARA fusion transcript on post-induction BM aspiration and biopsy. All patients achieved a molecular CR after consolidation (negative for PML-RARA). One patient relapsed 4 months after completion of consolidation therapy and achieved a second CR with ATRA and ATO. The median follow-up post-induction and post-consolidation was 41.5 and 33.5 months, respectively. All 12 patients are alive and remain in CR. High-risk APL patients can be successfully treated with ATRA/ATObased induction and consolidation without maintenance therapy, thus avoiding the long-term toxicities of maintenance therapy.