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- Title
Therapy-related acute promyelocytic leukemia: observations relating to APL pathogenesis and therapy.
- Authors
Elliott, Michelle A.; Letendre, Louis; Tefferi, Ayalew; Hogan, William J.; Hook, Christopher; Kaufmann, Scott H.; Pruthi, Rajiv K.; Pardanani, Animesh; Begna, Kebede H.; Ashrani, Aneel A.; Wolanskyj, Alexandra P.; Al-Kali, Aref; Litzow, Mark R.
- Abstract
Therapy-related acute promyelocytic leukemia (t-APL) is a well-recognized form of APL for which the underlying etiology has been well characterized. The pathogenesis of de novo (dn-APL) remains unknown; but epidemiologic studies have consistently identified increased body mass index (BMI), younger age, and ethnicity as possible risk factors. We analyzed demographics, clinical features, and treatment responses in a contemporary series of 64 patients treated with all- trans-retinoic acid and anthracycline-based therapy to assess for differences in these two etiologically distinct patient groups. Compared with patients with t-APL ( n = 11), those with dn-APL ( n = 53) had a greater median BMI (31.33 vs. 28.48), incidence of obesity (60.4% vs. 27.3%) ( P = 0.04), and history of hyperlipidemia (45.3% vs. 18.2%) ( P = 0.01). Fewer t-APL than dn-APL patients achieved complete remission at 63.6% vs. 92.5% respectively ( P = 0.008). This was the result of a higher induction mortality rate of 36.4% vs. 7.5% respectively ( P = 0.008). No cases of leukemic resistance were seen in either group. Overall survival (OS) was inferior in t-APL compared with dn-APL at 51% vs. 84%, respectively ( P < 0.005), primarily as a result of higher induction mortality. Relapse occurred in nine patients (16.1%) overall, but no relapses occurred in the t-APL cohort. Our observations provide further support for the hypothesis that abnormalities in lipid homeostasis may in some way be of pathogenic importance in dn-APL. Therapy-related APL is sensitive to standard therapy with no cases of resistance or relapse seen. The inferior OS of the t-APL was due to induction mortality, possibly reflecting prior therapy.
- Subjects
LEUKEMIA; ETIOLOGY of diseases; BODY mass index; OBESITY; HYPERLIPIDEMIA; MORTALITY
- Publication
European Journal of Haematology, 2012, Vol 88, Issue 3, p237
- ISSN
0902-4441
- Publication type
Article
- DOI
10.1111/j.1600-0609.2011.01727.x