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  3. Differentiation syndrome in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and anthracycline chemotherapy: characteristics, outcome, and prognostic factors

Differentiation syndrome in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and anthracycline chemotherapy: characteristics, outcome, and prognostic factors

Fecha de publicación:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Bergua, Juan M.
  • Vellenga, Edo
  • Rayon, Chelo
  • Parody, Ricardo
  • de la Serna, Javier
  • Leon, Angel
  • Esteve, Jordi
  • Milone, Gustavo
  • Deben, Guillermo
  • Rivas, Concha
  • Gonzalez, Marcos
  • Tormo, Mar
  • Diaz-Mediavilla, Joaquin
  • Gonzalez, Jose D.
  • Negri, Silvia
  • Amutio, Elena
  • Brunet, Salut
  • Lowenberg, Bob

Grupos

Abstract

Differentiation syndrome (DS) can be a life-threatening complication in patients with acute promyelocytic leukemia (APL) undergoing induction therapy with all-trans retinoic acid ( ATRA). Detailed knowledge about DS has remained limited. We present an analysis of the incidence, characteristics, prognostic factors, and outcome of 739 APL patients treated with ATRA plus idarubicin in 2 consecutive trials (Programa Espanol de Tratamientos en Hematologa [PETHEMA] LPA96 and LPA99). Overall, 183 patients (24.8%) experienced DS, 93 with a severe form (12.6%) and 90 with a moderate form (12.2%). Severe but not moderate DS was associated with an increase in mortality. A bimodal incidence of DS was observed, with peaks occurring in the first and third weeks after the start of ATRA therapy. A multivariate analysis indicated that a WBC count greater than 5 x 10(9)/L and an abnormal serum creatinine level correlated with an increased risk of developing severe DS. Patients receiving systematic prednisone prophylaxis (LPA99 trial) in contrast to those receiving selective prophylaxis with dexamethasone (LPA96 trial) had a lower incidence of severe DS. Patients developing severe DS showed a reduced 7-year relapse-free survival in the LPA96 trial (60% vs 85%, P = .003), but this difference was not apparent in the LPA99 trial (86% vs 88%). (Blood. 2009; 113: 775-783)

Datos de la publicación

ISSN/ISSNe:
0006-4971, 1528-0020

Blood  AMER SOC HEMATOLOGY

Tipo:
Article
Páginas:
775-783
PubMed:
18945964
Factor de Impacto:
5,834 SCImago ℠
Cuartil:
Q1 SCImago ℠

Citas Recibidas en Web of Science: 224

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Keywords

  • ACUTE MYELOID-LEUKEMIA; RANDOMIZED-TRIAL; RISK; IDARUBICIN; REMISSION; CONSOLIDATION; MULTICENTER; CYTARABINE; MANAGEMENT; MOLECULES

Campos de Estudio

Proyectos y Estudios Clínicos

RED DE INVESTIGACION COOPERATIVA DE CANCER

RD06/0020/0031 . INSTITUTO DE SALUD CARLOS III; FUNDACIÓN PARA LA INVESTIGACIÓN DEL HOSPITAL UNIVERSITARIO LA FE DE LA COMUNIDAD VALENCIANA . 2006

ESTUDIO ALEATORIZADO, DOBLE-CIEGO, CONTROLADO CON PLACEBO PARA EVALUAR LA EFICACIA Y SEGURIDAD DE ROMIPLOSTIM EN EL TRATAMIENTO DE LA TROMBOCITOPENIA EN PACIENTES CON SINDROME MIELODISPLASICO (SMD) DE RIESGO BAJO O INTERMEDIO-1.

Investigador Principal: MIGUEL ÁNGEL SANZ ALONSO

20060198 . 2008

MANEJO CLINICO DE LA PURPURA TROMBOCITOPENICA IDIOPATICA CRONICA EN ESPAÑA

Investigador Principal: MIGUEL ÁNGEL SANZ ALONSO

04107 . 2008

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