Early Death and Survival of Patients With Acute Promyelocytic Leukemia in ATRA Plus Arsenic Era: A Population-Based Study

Most randomized trials for acute promyelocytic leukemia (APL) have investigated highly selected patients under idealized conditions, and the findings need to be validated in the real world. We conducted a population-based study of all APL patients in Zhejiang Province, China, with a total population...

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Published inFrontiers in oncology Vol. 11; p. 762653
Main Authors Zhu, Hong-Hu, Ma, Ya-Fang, Yu, Kang, Ouyang, Gui-Fang, Luo, Wen-Da, Pei, Ren-Zhi, Xu, Wei-Qun, Hu, Hui-Xian, Mo, Shu-Ping, Xu, Xiao-Hua, Lan, Jian-Ping, Shen, Jian-Ping, Shou, Li-Hong, Qian, Shen-Xian, Feng, Wei-Ying, Zhao, Pu, Jiang, Jin-Hong, Hu, Bei-Li, Zhang, Jin, Qian, Su-Ying, Wu, Gong-Qiang, Wu, Wen-Ping, Qiu, Lei, Li, Lin-Jie, Lang, Xiang-Hua, Chen, Sai, Chen, Li-Li, Guo, Jun-Bin, Cao, Li-Hong, Jiang, Hui-Fang, Xia, Yong-Ming, Le, Jing, Zhao, Jian-Zhi, Huang, Jian, Zhang, Yue-Feng, Lv, Ya-Li, Hua, Jing-Sheng, Hong, Yong-Wei, Zheng, Cui-Ping, Wang, Ju-Xiang, Hu, Bin-Fei, Chen, Xiao-Hui, Zhang, Li-Ming, Tao, Shi, Xie, Bing-Shou, Kuang, Yue-Min, Luo, Wen-Ji, Su, Ping, Guo, Jun, Wu, Xiao, Jiang, Wei, Zhang, Hui-Qi, Zhang, Yun, Chen, Chun-Mei, Xu, Xiao-Feng, Guo, Yan, Tu, Jin-Ming, Hu, Shao, Yan, Xiao-Yan, Yao, Chen, Lou, Yin-Jun, Jin, Jie
Format Journal Article
LanguageEnglish
Published Frontiers Media S.A 16.11.2021
Subjects
acute promyelocytic leukemia
arsenic
ATRA
early death
Oncology
survival
Online AccessGet full text
ISSN2234-943X
2234-943X
DOI10.3389/fonc.2021.762653

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Abstract Most randomized trials for acute promyelocytic leukemia (APL) have investigated highly selected patients under idealized conditions, and the findings need to be validated in the real world. We conducted a population-based study of all APL patients in Zhejiang Province, China, with a total population of 82 million people, to assess the generalization of all-trans retinoic acid (ATRA) and arsenic as front-line treatment. The outcomes of APL patients were also analyzed. Between January 2015 and December 2019, 1,233 eligible patients were included in the final analysis. The rate of ATRA and arsenic as front-line treatment increased steadily from 66.2% in 2015 to 83.3% in 2019, with no difference among the size of the center (≥5 or <5 patients per year, p = 0.12) or age (≥60 or <60 years, p = 0.35). The early death (ED) rate, defined as death within 30 days after diagnosis, was 8.2%, and the 3-year overall survival (OS) was 87.9% in the whole patient population. Age (≥60 years) and white blood cell count (>10 × 10 9 /L) were independent risk factors for ED and OS in the multivariate analysis. This population-based study showed that ATRA and arsenic as front-line treatment are widely used under real-world conditions and yield a low ED rate and a high survival rate, which mimic the results from clinical trials, thereby supporting the wider application of APL guidelines in the future.
AbstractList Most randomized trials for acute promyelocytic leukemia (APL) have investigated highly selected patients under idealized conditions, and the findings need to be validated in the real world. We conducted a population-based study of all APL patients in Zhejiang Province, China, with a total population of 82 million people, to assess the generalization of all-trans retinoic acid (ATRA) and arsenic as front-line treatment. The outcomes of APL patients were also analyzed. Between January 2015 and December 2019, 1,233 eligible patients were included in the final analysis. The rate of ATRA and arsenic as front-line treatment increased steadily from 66.2% in 2015 to 83.3% in 2019, with no difference among the size of the center (≥5 or <5 patients per year, p = 0.12) or age (≥60 or <60 years, p = 0.35). The early death (ED) rate, defined as death within 30 days after diagnosis, was 8.2%, and the 3-year overall survival (OS) was 87.9% in the whole patient population. Age (≥60 years) and white blood cell count (>10 × 10 9 /L) were independent risk factors for ED and OS in the multivariate analysis. This population-based study showed that ATRA and arsenic as front-line treatment are widely used under real-world conditions and yield a low ED rate and a high survival rate, which mimic the results from clinical trials, thereby supporting the wider application of APL guidelines in the future.
Most randomized trials for acute promyelocytic leukemia (APL) have investigated highly selected patients under idealized conditions, and the findings need to be validated in the real world. We conducted a population-based study of all APL patients in Zhejiang Province, China, with a total population of 82 million people, to assess the generalization of all-trans retinoic acid (ATRA) and arsenic as front-line treatment. The outcomes of APL patients were also analyzed. Between January 2015 and December 2019, 1,233 eligible patients were included in the final analysis. The rate of ATRA and arsenic as front-line treatment increased steadily from 66.2% in 2015 to 83.3% in 2019, with no difference among the size of the center (≥5 or <5 patients per year, p = 0.12) or age (≥60 or <60 years, p = 0.35). The early death (ED) rate, defined as death within 30 days after diagnosis, was 8.2%, and the 3-year overall survival (OS) was 87.9% in the whole patient population. Age (≥60 years) and white blood cell count (>10 × 109/L) were independent risk factors for ED and OS in the multivariate analysis. This population-based study showed that ATRA and arsenic as front-line treatment are widely used under real-world conditions and yield a low ED rate and a high survival rate, which mimic the results from clinical trials, thereby supporting the wider application of APL guidelines in the future.
Most randomized trials for acute promyelocytic leukemia (APL) have investigated highly selected patients under idealized conditions, and the findings need to be validated in the real world. We conducted a population-based study of all APL patients in Zhejiang Province, China, with a total population of 82 million people, to assess the generalization of all-trans retinoic acid (ATRA) and arsenic as front-line treatment. The outcomes of APL patients were also analyzed. Between January 2015 and December 2019, 1,233 eligible patients were included in the final analysis. The rate of ATRA and arsenic as front-line treatment increased steadily from 66.2% in 2015 to 83.3% in 2019, with no difference among the size of the center (≥5 or <5 patients per year, p = 0.12) or age (≥60 or <60 years, p = 0.35). The early death (ED) rate, defined as death within 30 days after diagnosis, was 8.2%, and the 3-year overall survival (OS) was 87.9% in the whole patient population. Age (≥60 years) and white blood cell count (>10 × 109/L) were independent risk factors for ED and OS in the multivariate analysis. This population-based study showed that ATRA and arsenic as front-line treatment are widely used under real-world conditions and yield a low ED rate and a high survival rate, which mimic the results from clinical trials, thereby supporting the wider application of APL guidelines in the future.Most randomized trials for acute promyelocytic leukemia (APL) have investigated highly selected patients under idealized conditions, and the findings need to be validated in the real world. We conducted a population-based study of all APL patients in Zhejiang Province, China, with a total population of 82 million people, to assess the generalization of all-trans retinoic acid (ATRA) and arsenic as front-line treatment. The outcomes of APL patients were also analyzed. Between January 2015 and December 2019, 1,233 eligible patients were included in the final analysis. The rate of ATRA and arsenic as front-line treatment increased steadily from 66.2% in 2015 to 83.3% in 2019, with no difference among the size of the center (≥5 or <5 patients per year, p = 0.12) or age (≥60 or <60 years, p = 0.35). The early death (ED) rate, defined as death within 30 days after diagnosis, was 8.2%, and the 3-year overall survival (OS) was 87.9% in the whole patient population. Age (≥60 years) and white blood cell count (>10 × 109/L) were independent risk factors for ED and OS in the multivariate analysis. This population-based study showed that ATRA and arsenic as front-line treatment are widely used under real-world conditions and yield a low ED rate and a high survival rate, which mimic the results from clinical trials, thereby supporting the wider application of APL guidelines in the future.
Author Yao, Chen
Ma, Ya-Fang
Xu, Xiao-Hua
Zhang, Li-Ming
Feng, Wei-Ying
Li, Lin-Jie
Qiu, Lei
Le, Jing
Jiang, Hui-Fang
Shen, Jian-Ping
Qian, Shen-Xian
Yu, Kang
Huang, Jian
Pei, Ren-Zhi
Zheng, Cui-Ping
Xu, Wei-Qun
Xia, Yong-Ming
Chen, Xiao-Hui
Wang, Ju-Xiang
Su, Ping
Wu, Xiao
Zhang, Jin
Wu, Wen-Ping
Luo, Wen-Ji
Chen, Chun-Mei
Wu, Gong-Qiang
Kuang, Yue-Min
Hu, Hui-Xian
Hong, Yong-Wei
Tu, Jin-Ming
Zhu, Hong-Hu
Cao, Li-Hong
Mo, Shu-Ping
Zhao, Jian-Zhi
Guo, Yan
Jiang, Wei
Hu, Shao
Hu, Bei-Li
Shou, Li-Hong
Hua, Jing-Sheng
Chen, Li-Li
Lou, Yin-Jun
Jin, Jie
Tao, Shi
Lv, Ya-Li
Xie, Bing-Shou
Lan, Jian-Ping
Zhang, Yue-Feng
Jiang, Jin-Hong
Lang, Xiang-Hua
Guo, Jun-Bin
Xu, Xiao-Feng
Yan, Xiao-Yan
Zhang, Yun
Luo, Wen-Da
Chen, Sai
Hu, Bin-Fei
Qian, Su-Ying
Zhang, Hui-Qi
Guo, Jun
Zhao, Pu
Ouyang, Gui-Fang
AuthorAffiliation 23 Department of Hematology, Dongyang Hospital Affiliated to Wenzhou Medical University , Jinhua , China
32 Department of Hematology, Tongde Hospital of Zhejiang Province , Hangzhou , China
35 Department of Hematology, Shaoxing Central Hospital , Shaoxing , China
34 Department of Hematology and Oncology, Ningbo Medical Center Lihuili Hospital , Ningbo , China
30 Department of Hematology and Oncology, The First People’s Hospital of Wenling , Taizhou , China
26 Department of Hematology, Lishui Municipal Central Hospital , Jinhua , China
60 Department of Hematology and Oncology, The First Hospital of Ninghai County , Ningbo , China
56 Department of Hematotherapeutic, The Second Affiliated Hospital of Zhejiang Chinese Medical University , Hangzhou , China
58 Department of Hematology, The First People’s Hospital of Pinghu , Jiaxing , China
16 Department of Hematology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine , Hangzhou , China
40 Department of Hematology, Ni
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– name: 15 Department of Hematology, Huzhou Central Hospital , Huzhou , China
– name: 50 Department of Hematology, Zhejiang Xiaoshan Hospital , Hangzhou , China
– name: 47 Department of Hematology, Wenzhou People’s Hospital , Wenzhou , China
– name: 41 Department of Hematotherapeutic, Wenzhou Central Hospital Medical Group , Wenzhou , China
– name: 56 Department of Hematotherapeutic, The Second Affiliated Hospital of Zhejiang Chinese Medical University , Hangzhou , China
– name: 43 Department of Pediatric Hematology, Ningbo Women and Children’s Hospital , Ningbo , China
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– name: 12 Department of Hematology, The Second Affiliated Hospital Zhejiang University School of Medicine , Hangzhou , China
– name: 39 Department of Hematology and Oncology, Taizhou Municipal Hospital , Taizhou , China
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– name: 51 Department of Hematology and Oncology, The Sencond Affiliated Hospital of Zhejiang University, SAHZU Changxing Branch , Huzhou , China
– name: 54 Department of Hematology, The First People’s Hospital of Huzhou , Huzhou , China
– name: 53 Department of Hematology, Shangyu People’s Hospital , Shaoxing , China
– name: 8 Department of Hematology, The Affiliated People’s Hospital of Ningbo University , Ningbo , China
– name: 6 Department of Hematology, Ningbo First Hospital , Ningbo , China
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– name: 33 Department of Hematology, Rheumatology and Nephrology, Yuyao People’s Hospital, Ningbo University Yangming Affiliated Hospital , Ningbo , China
– name: 38 Department of Hematology, Xinchang People’s Hospital , Shaoxing , China
– name: 45 Department of Hematology, Zhuji People’s Hospital , Shaoxing , China
– name: 57 Department of Oncology and Hematology, Hangzhou Red Cross Hospital , Hangzhou , China
– name: 11 Department of Hematology, The Affiliated Hospital of Jiaxing University , Jiaxing , China
– name: 20 Department of Hematology, The Second Affiliated Hospital of Jiaxing University , Jiaxing , China
– name: 4 Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center , Hangzhou , China
– name: 24 Department of Hematology, People’s Hospital of Quzhou , Quzhou , China
– name: 32 Department of Hematology, Tongde Hospital of Zhejiang Province , Hangzhou , China
– name: 9 Department of Hematology, The Children’s Hospital Zhejiang University School of Medicine , Hangzhou , China
– name: 37 Department of Hematology, The First People’s Hospital of Yuhang District , Hangzhou , China
– name: 55 Department of Hematotherapeutic, Yueqing People’s Hospital , Wenzhou , China
– name: 3 Zhejiang University Cancer Center , Hangzhou , China
– name: 27 Department of Hematology, The First People’s Hospital of Yongkang , Jinhua , China
– name: 28 Department of Hematology, Taizhou Central Hospital (Taizhou University Hospital) , Taizhou , China
– name: 44 Department of Hematology, The Affiliated Hospital of Hangzhou Normal University , Hangzhou , China
– name: 10 Department of Hematology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine , Jinhua , China
– name: 31 Department of Hematology, Shulan Hospital , Hangzhou , China
– name: 29 Department of Hematology and Oncology, Taizhou First People’s Hospital (Huangyan Hospital of Wenzhou Medical University) , Taizhou , China
– name: 16 Department of Hematology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine , Hangzhou , China
– name: 14 Department of Hematology, Zhejiang Provincial Hospital of Chinese Medicine , Hangzhou , China
– name: 22 Department of Hematology, Hwa Mei Hospital, University of Chinese Academy of Sciences , Ningbo , China
– name: 26 Department of Hematology, Lishui Municipal Central Hospital , Jinhua , China
– name: 42 Department of Hematology and Oncology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University , Wenzhou , China
– name: 30 Department of Hematology and Oncology, The First People’s Hospital of Wenling , Taizhou , China
– name: 35 Department of Hematology, Shaoxing Central Hospital , Shaoxing , China
– name: 48 Department of Hematology, Jinhua People’s Hospital , Jinhua , China
– name: 2 Key Laboratory of Hematologic Malignancies, Diagnosis and Treatment , Hangzhou , China
– name: 5 Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University , Hangzhou , China
– name: 21 Department of Hematology, Sir Run Run Shaw Hospital (SRRSH) Affiliated with the Zhejiang University School of Medicine , Hangzhou , China
– name: 58 Department of Hematology, The First People’s Hospital of Pinghu , Jiaxing , China
– name: 34 Department of Hematology and Oncology, Ningbo Medical Center Lihuili Hospital , Ningbo , China
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– name: 23 Department of Hematology, Dongyang Hospital Affiliated to Wenzhou Medical University , Jinhua , China
– name: 60 Department of Hematology and Oncology, The First Hospital of Ninghai County , Ningbo , China
– name: 40 Department of Hematology, Ningbo Yinzhou No. 2 Hospital , Ningbo , China
– name: 59 Department of Gastroenterology and Hematology, Longyou People’s Hospital , Quzhou , China
– name: 25 Department of Hematology, Zhoushan Hospital , Zhoushan , China
– name: 52 Department of Oncology and Hematology, The Affiliated Hospital of Medical School of Ningbo University , Ningbo , China
– name: 36 Department of Hematology, The Fourth Affiliated Hospital Zhejiang University School of Medicine , Jinhua , China
– name: 46 Department of Hematology, Shaoxing Second Hospital , Shaoxing , China
– name: 17 Department of Hematology, Shaoxing People’s Hospital , Wenzhou , China
– name: 49 Department of Hematology, The First People’s Hospital of Xiaoshan District , Hangzhou , China
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Copyright Copyright © 2021 Zhu, Ma, Yu, Ouyang, Luo, Pei, Xu, Hu, Mo, Xu, Lan, Shen, Shou, Qian, Feng, Zhao, Jiang, Hu, Zhang, Qian, Wu, Wu, Qiu, Li, Lang, Chen, Chen, Guo, Cao, Jiang, Xia, Le, Zhao, Huang, Zhang, Lv, Hua, Hong, Zheng, Wang, Hu, Chen, Zhang, Tao, Xie, Kuang, Luo, Su, Guo, Wu, Jiang, Zhang, Zhang, Chen, Xu, Guo, Tu, Hu, Yan, Yao, Lou, Jin and the APL Cooperative Group of Zhejiang Province.
Copyright © 2021 Zhu, Ma, Yu, Ouyang, Luo, Pei, Xu, Hu, Mo, Xu, Lan, Shen, Shou, Qian, Feng, Zhao, Jiang, Hu, Zhang, Qian, Wu, Wu, Qiu, Li, Lang, Chen, Chen, Guo, Cao, Jiang, Xia, Le, Zhao, Huang, Zhang, Lv, Hua, Hong, Zheng, Wang, Hu, Chen, Zhang, Tao, Xie, Kuang, Luo, Su, Guo, Wu, Jiang, Zhang, Zhang, Chen, Xu, Guo, Tu, Hu, Yan, Yao, Lou, Jin and the APL Cooperative Group of Zhejiang Province 2021 Zhu, Ma, Yu, Ouyang, Luo, Pei, Xu, Hu, Mo, Xu, Lan, Shen, Shou, Qian, Feng, Zhao, Jiang, Hu, Zhang, Qian, Wu, Wu, Qiu, Li, Lang, Chen, Chen, Guo, Cao, Jiang, Xia, Le, Zhao, Huang, Zhang, Lv, Hua, Hong, Zheng, Wang, Hu, Chen, Zhang, Tao, Xie, Kuang, Luo, Su, Guo, Wu, Jiang, Zhang, Zhang, Chen, Xu, Guo, Tu, Hu, Yan, Yao, Lou, Jin and the APL Cooperative Group of Zhejiang Province
Copyright_xml – notice: Copyright © 2021 Zhu, Ma, Yu, Ouyang, Luo, Pei, Xu, Hu, Mo, Xu, Lan, Shen, Shou, Qian, Feng, Zhao, Jiang, Hu, Zhang, Qian, Wu, Wu, Qiu, Li, Lang, Chen, Chen, Guo, Cao, Jiang, Xia, Le, Zhao, Huang, Zhang, Lv, Hua, Hong, Zheng, Wang, Hu, Chen, Zhang, Tao, Xie, Kuang, Luo, Su, Guo, Wu, Jiang, Zhang, Zhang, Chen, Xu, Guo, Tu, Hu, Yan, Yao, Lou, Jin and the APL Cooperative Group of Zhejiang Province.
– notice: Copyright © 2021 Zhu, Ma, Yu, Ouyang, Luo, Pei, Xu, Hu, Mo, Xu, Lan, Shen, Shou, Qian, Feng, Zhao, Jiang, Hu, Zhang, Qian, Wu, Wu, Qiu, Li, Lang, Chen, Chen, Guo, Cao, Jiang, Xia, Le, Zhao, Huang, Zhang, Lv, Hua, Hong, Zheng, Wang, Hu, Chen, Zhang, Tao, Xie, Kuang, Luo, Su, Guo, Wu, Jiang, Zhang, Zhang, Chen, Xu, Guo, Tu, Hu, Yan, Yao, Lou, Jin and the APL Cooperative Group of Zhejiang Province 2021 Zhu, Ma, Yu, Ouyang, Luo, Pei, Xu, Hu, Mo, Xu, Lan, Shen, Shou, Qian, Feng, Zhao, Jiang, Hu, Zhang, Qian, Wu, Wu, Qiu, Li, Lang, Chen, Chen, Guo, Cao, Jiang, Xia, Le, Zhao, Huang, Zhang, Lv, Hua, Hong, Zheng, Wang, Hu, Chen, Zhang, Tao, Xie, Kuang, Luo, Su, Guo, Wu, Jiang, Zhang, Zhang, Chen, Xu, Guo, Tu, Hu, Yan, Yao, Lou, Jin and the APL Cooperative Group of Zhejiang Province
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Reviewed by: Roberto Latagliata, Unitelma Sapienza University, Italy; Michael Richard Grunwald, Levine Cancer Institute, United States; Miguel A. Sanz, Instituo de Investigación Sanitaria La Fe, Spain
Edited by: Anna Maria Testi, Sapienza University of Rome, Italy
These authors have contributed equally to this work and share first authorship
This article was submitted to Hematologic Malignancies, a section of the journal Frontiers in Oncology
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Title Early Death and Survival of Patients With Acute Promyelocytic Leukemia in ATRA Plus Arsenic Era: A Population-Based Study
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