medigraphic.com

2011, Number 3

<< Back Next >>

Rev Hematol Mex 2011; 12 (3)

Experience of the acute promyelocytic leukemia treatment in an Institution of Mexico City

Ramos-Peñafiel C, Montaño-Figueroa E, Martínez-Tovar A, Castellanos-Sinco H, Olarte-Carrillo I, Zamora-Domínguez J, Rozen-Fuller E, Martínez-Murillo C, Collazo-Jaloma J

Language: Spanish
References: 29
Page: 125-130
PDF size: 100.20 Kb.


ABSTRACT

Background: The acute promyelocytic leukemia is a type of acute leukemia which has a higher incidence in Latin America compared to other world regions. Its origin is secondary mainly, to the t(15;17) that encoding the fusion transcript PML/RARα.
Material and method: The treatment consist in the use of trans-retinoic-acid in conjunction with anthracyclines in the induction stage, with this strategy, the remission rate is above 70% with an overall survival of 80% at 5 years. The delayed onset of therapy with ATRA increases mortality associated with bleeding. In the Hospital General de México since 2001 was established institutional protocol HGMLAP2001, the median age was 35 years (range 16-58years). The percentage of complete remissions was 71%, with an induction mortality of 29%, this was mostly secondary to bleeding events. The differentiation syndrome appeared only in 11.5%. The relapse rate was 15.3 %. The overall survival at 2 and 5 years was 65% and 45% respectively. The detection of minimal residual disease at maintenance was statistically significant for molecular relapse (p=0.045).
Conclusions: Incidence of acute promyelocytic leukemia is higher in American mestizo. Early diagnosis and treatment are the most important strategies to reduce mortality.


REFERENCES

  1. Tallman MS, Altman JK. How I treat acute promyelocytic leukemia. Blood 2009;34(3):393-398.

  2. Salomoni P. Stemming out of a new PML era? Cell Death Differ 2009;16(8): 1083-1092.

  3. Salomoni P, Ferguson BJ, Wyllie AH, Rich T. New insights into the role of PML in tumor suppression. Cell Res 2008;18(6):622-640.

  4. Lo-Coco F, Ammatuna E, Montesinos P, Sanz MA. Acute promyelocytic leukemia: recent advances in diagnosis and management. Semin Oncol 2008;35(4):401-409.

  5. Sanz MA. Treatment of acute promyelocytic leukemia. Hematology Am Soc Hematol Educ Program 2006;147-155.

  6. Tallman MS. Updates on the treatment of acute promyelocytic leukemia. Clin Adv Hematol Oncol 2010;8(2):89-90.

  7. Sanz MA, Montesinos P, Vellenga E, Rayón C, et al. Riskadapted treatment of acute promyelocytic leukemia with all-trans retinoica cid and anthracycline monochemotherapy: long-term outcome of the LPA 99 multicenter study by the PETHEMA Group. Blood 2008;112(8):3130-3134.

  8. Sanz MA, Martín G, Rayón C, Esteve J, et al. A modified AIDA protocol with anthtacycline-based consolidation results in high antileukemic efficacy and reduced toxicity in newly diagnosed PML/RARalpha-positive acute promyelocytic leukemia. PETHEMA group. Blood 1999;94(9):3015-3021.

  9. Breccia M, Latagliata R, Cannella L, Minotti C, et al. Early hemorrhagic death before starting therapy in acute promyelocytic leukemia: association with high WBC count, late diagnosis and delayed treatment initiation. Haematologica 2010;95(5):853-854.

  10. Stein E, McMahon B, Kwaan H, Altman JK, et al. The coagulopathy of acute promyelocytic leukaemia revisited. Best Pract Res Clin Haematol 2009;22(1):153-163.

  11. Wang ZY, Chen Z. Acute promyelocytic leukemia: from highly fatal to highly curable. Blood ;111 (5): 2505-2515.

  12. Douer D. The epidemiology of acute promyelocytic leukemia. Best Pract Res Haematol 2003;16(3):357-367.

  13. Douer D, Santillana S, Ramezani L, Samanez C, et al. Acute promyelocytic leukaemia in patients originating in Latin America is associated with an increased frequency of the bcr1 subtype of the PML/RARalpha fusion gene. Br J Haematol 2003;122(4):563-570.

  14. Pagnano KB, de Carvalho Duarte G, Lorand-Metze I, Delamain MT, et al. Treatment outcome of acute promyelocytic leukemia with modified AIDA protocol. Adv Hematol 2010;10:672-637.

  15. Dombret H, Scrobohaci ML, Ghorra P, Zini JM, et al. Coagulation disorders associated with acute promyelocytic leukemia: corrective effect of all-trans retinoic acid treatment. Leukemia 1993;7(1):2-9.

  16. Arbuthnot C, Wilde JT. Haemostatic problems in acute promyelocytic leukaemia. Blood Rev 2006;20(6):289-297.

  17. Tallman MS, Lefèbvre P, Baine RM, Shoji M, Cohen I, Green D. Effects of all-trans retinoic acid or chemotherapy on the molecular regulation of systemic blood coagulation and fibrinolysis in patients with acute promyelocytic leukemia. J Thromb Haemost 2004;2(8):1341-1350.

  18. Sanz MA, Grimwade D, Tallman MS, Lowenberg B, et al. Management of acute pomyelocytic leukemia: recommendations from an expert panel on behalf of the European LeukemiaNet. Blood 2009;113 (9):1875-1891.

  19. Induction therapy with idarubicin alone significantly influences event-free survival duration in patients with newly diagnosed hypergranular acute promyelocytic leukemia: final results of the GIMEMA randomized study LAP 0389 with 7 years of minimal follow-up. Blood 2002;100(9):3141-3146.

  20. Avvisati G, Lo-Coco F, Paoloni FP, Petti MC, et al. AIDA 0493 protocol for newly diagnosed acute promyelocytic leukemia: very long-term results and role of maintenance. Blood 2011;117(18):4716-4725.

  21. Puga BL, Cabrera ME, Undurraga MS, Etcheverry R, et al. Acute myeloid leukemia in the adult. Results of the National Antineoplasic Drug Protocol at the Hospital del Salvador, 1990-1998. Rev Med Chil 2000;128(11):1191-1198.

  22. Jácomo RH, Melo RA, Souto FR, de Mattos ER, et al. Haematologica 2007;92(10):1431-1432.

  23. Ruiz-Argüelles G, Morales-Toquero A, Gómez-Rangel J, López-Martínez B, et al. Treatment of acute promyelocytic leukemia: A single institution experience. Revista de Investigación Clínica 2005;57(3):415-419.

  24. Ruiz-Argüelles G, Lobato-Mendizábal E, Delgado-Lamas JL, Gómez-Almaguer D. All trans-retinoic acid decreases early mortality in patients with promyelocytic leukemia and can be given entirely on an outpatient basis. Am J Hematol 1999;62(3):139-143.

  25. Ruiz-Argüelles GJ, Garcés-Eisele J, Reyes-Núñez V, Gómez-Rangel JD, Ruiz-Delgado GJ. More on geographic hematology: the breakpoint cluster regions of the PML/RARalpha fusion gene in Mexican Mestizo patients with promyelocytic leukemia are different from those in Caucasians. Leuk Limphoma 2004;45(7):1365-1368.

  26. Polampalli S, Choughule A, Prabhash K, Amare P, et al. Role of RT-PCR and FISH in diagnosis and monitoring of acute promyelocytic leukemia. Indian J Cancer 2011;48(1):60-67.

  27. Jurcic J, Nimer S, Scheinberg D, DeBlasio T, Warrell R. Prognostic significance of minimal residual disease detection and PML/RAR-α isoform type: long-term follow up in acute promyelocytic leukemia. Blood 2001;98:2651-2556.

  28. De la Serna J, Montesinos P, Vellenga E, Rayón C, et al. Causes and prognostic factors of remission induction failure in patients with acute promyelocytic leukemia treated with all-trans retinoic and idarubicin. Blood 2008;111(7):3395-3402.

  29. Santamaría C, Chillón MC, Fernández C, Martín-Jiménez P, et al. Using quantification of the PML-RARalpha transscript to stratify the risk of relapse in patients with acute promyelocytic leukemia. Haematologica 2007;92(3):315-322.




2020     |     www.medigraphic.com