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
Por:
Montesinos, P, Diaz-Mediavilla, J, Deben, G, Prates, V, Tormo, M, Rubio, V, Perez, I, Fernandez, I, Viguria, M, Rayon, C, Gonzalez, J, de la Serna, J, Esteve, J, Bergua, JM, Rivas, C, Gonzalez, M, Gonzalez, JD, Negri, S, Brunet, S, Lowenberg, B, Sanz, MA
Publicada:
1 sep 2009
Resumen:
Background
The prevalence of and risk factors for central nervous system recurrence in patients with acute promyelocytic leukemia are not well established and remain a controversial matter.
Design and Methods
Between 1996 and 2005, 739 patients with newly diagnosed acute promyelocytic leukemia enrolled in two consecutive trials (PETHEMA LPA96 and LPA99) received induction therapy-with all-trans retinoic acid and idarubicin. Consolidation therapy comprised three courses of anthracycline monochemotherapy (LPA96), with all-trans retinoic acid and reinforced doses of idarubicin in patients with an intermediate or high risk of relapse (LPA99). Central nervous system prophylaxis was not given.
Results
Central nervous system relapse was documented in 11 patients. The 5-year cumulative incidence of central nervous system relapse was 1.7% (LPA96 3.2% and LPA99 1.2%; p=0.09). The cumulative incidence was 0%, 0.8%, and 5.5% in low-, intermediate-, and high-risk patients, respectively. Relapse risk score (p=0.0001) and the occurrence of central nervous system hemorrhage during induction (5-year cumulative incidence 18.7%, p=0.006) were independent risk factors for central nervous system relapse.
Conclusions
This study shows a low incidence of central nervous system relapse in patients with acute promyelocytic leukemia following therapy with all-trans retinoic acid and anthracycline without specific central nervous system prophylaxis. Central nervous system relapse was significantly associated with high white blood cell counts and prior central nervous system hemorrhage, which emerged as independent prognostic factors.
Filiaciones:
Montesinos, P:
Hosp Univ La Fe, Dept Hematol, Valencia 46009, Spain
Diaz-Mediavilla, J:
Hosp Clin San Carlos, Madrid, Spain
Deben, G:
Hosp Juan Canalejo, La Coruna, Spain
Prates, V:
Inst Trasplante Medula Osea, Buenos Aires, DF, Argentina
Tormo, M:
Hosp Clin Univ, Valencia, Spain
Rubio, V:
Gen Hosp, Jerez de la Frontera, Spain
Perez, I:
Hosp Univ Virgen de la Victoria, Malaga, Spain
Fernandez, I:
Fundaleu, Buenos Aires, DF, Argentina
Viguria, M:
Hosp Navarra, Pamplona, Spain
Rayon, C:
Univ Oviedo, Hosp Cent Asturias, E-33080 Oviedo, Spain
Gonzalez, J:
Hosp Univ Virgen del Rocio, Seville, Spain
Hosp Insular, Las Palmas Gran Canaria, Spain
de la Serna, J:
Hosp 12 Octubre, E-28041 Madrid, Spain
Esteve, J:
Hosp Clin Barcelona, Barcelona, Spain
Bergua, JM:
Hosp San Pedro de Alcantara, Caceres, Spain
Rivas, C:
Gen Hosp, Alicante, Spain
Gonzalez, M:
Univ Hosp, Salamanca, Spain
Gonzalez, JD:
Hosp Insular, Las Palmas Gran Canaria, Spain
Negri, S:
Hosp Carlos Haya, Malaga, Spain
Brunet, S:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Lowenberg, B:
Erasmus Univ, Med Ctr, Rotterdam, Netherlands
Sanz, MA:
Hosp Univ La Fe, Dept Hematol, Valencia 46009, Spain
Gold, Green Published
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