TY - JOUR
T1 - Optimizing treatment for elderly patients with acute promyelocytic leukemia
T2 - Is it time to replace chemotherapy with all-trans retinoic acid and arsenic trioxide?
AU - Tsimberidou, Apostolia Maria
AU - Kantarjian, Hagop
AU - Keating, Michael J.
AU - Estey, Elihu
PY - 2006/11
Y1 - 2006/11
N2 - This review focuses on the treatment of acute promyelocytic leukemia (APL) in elderly patients and offers recommendations for improving outcomes. Nineteen percent of patients with APL are ≫60 years. Rates of response and survival are lower in elderly compared with younger patients, owing to a higher incidence of early deaths or deaths in remission. However, relapse-free survival rates are similar in both groups. Ongoing trials assess the role of reduced-intensity regimens. All-trans retinoic acid (ATRA) and concurrent arsenic trioxide is associated with high rates of response and molecular remission and low rates of induction deaths. We propose this combination as the treatment of choice in patients with APL, including the elderly. Patients with elevated leukocyte counts may also benefit from gemtuzumab ozogamicin therapy, with or without leukapheresis. Monitoring major organ function and toxicity is essential. Patients should be assessed for minimal residual disease using polymerase chain reaction testing for promyelocytic leukemia-retinoic acid receptor alpha. If molecular relapse is evident, treatment with ATRA and idarubicin, with or without gemtuzumab ozogamicin, is recommended.
AB - This review focuses on the treatment of acute promyelocytic leukemia (APL) in elderly patients and offers recommendations for improving outcomes. Nineteen percent of patients with APL are ≫60 years. Rates of response and survival are lower in elderly compared with younger patients, owing to a higher incidence of early deaths or deaths in remission. However, relapse-free survival rates are similar in both groups. Ongoing trials assess the role of reduced-intensity regimens. All-trans retinoic acid (ATRA) and concurrent arsenic trioxide is associated with high rates of response and molecular remission and low rates of induction deaths. We propose this combination as the treatment of choice in patients with APL, including the elderly. Patients with elevated leukocyte counts may also benefit from gemtuzumab ozogamicin therapy, with or without leukapheresis. Monitoring major organ function and toxicity is essential. Patients should be assessed for minimal residual disease using polymerase chain reaction testing for promyelocytic leukemia-retinoic acid receptor alpha. If molecular relapse is evident, treatment with ATRA and idarubicin, with or without gemtuzumab ozogamicin, is recommended.
KW - APL
KW - All-trans retinoic acid
KW - Elderly
KW - Molecular remission
KW - White blood cell count
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U2 - 10.1080/10428190600807178
DO - 10.1080/10428190600807178
M3 - Review article
C2 - 17107899
AN - SCOPUS:33751116539
SN - 1042-8194
VL - 47
SP - 2282
EP - 2287
JO - Leukemia and Lymphoma
JF - Leukemia and Lymphoma
IS - 11
ER -