Document Detail


Treatment of relapsed or refractory acute promyelocytic leukemia.
MedLine Citation:
PMID:  17336255     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Current treatment for acute promyelocytic leukemia (APL) usually includes an induction phase with all-trans retinoic acid (ATRA) and anthracycline-based chemotherapy, followed by a consolidation phase of anthracycline-based chemotherapy and maintenance therapy with ATRA with or without low-dose chemotherapy for 1-2 years. This treatment strategy results in a high complete remission (CR) rate of about 90% and an overall survival rate of 80%. About 5%-30% of patients relapse, mainly patients with high-risk APL. Relapse at extramedullary sites, which occurs in approximately 3%-5% of patients, is emerging as a new issue. Treatment of relapsed/advanced APL includes the use of arsenic trioxide (ATO), gemtuzumab ozogamicin, and hematopoietic stem cell transplantation. ATO is currently the most effective therapeutic agent in relapsed APL. Hematopoietic stem cell transplantation is becoming a common strategy after achieving remission with ATO. Autologous transplant appears to have a more favorable outcome than allogeneic transplant in this setting, particularly when carried out during second remission, primarily because of significantly higher treatment-related mortality with allogeneic transplants. Allogeneic transplant, however, should be strongly considered for patients who remain molecularly positive. Future directions for APL therapy should include developing agents that can prevent relapse, particularly for high-risk patients. Other future treatment strategies may include use of ATO administered concomitantly or sequentially with chemotherapy, gemtuzumab or FLT-3 inhibitors that may obviate the need for autologous transplantation, and posttransplant maintenance perhaps with FLT-3 inhibitors.
Authors:
Martin S Tallman
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Best practice & research. Clinical haematology     Volume:  20     ISSN:  1521-6926     ISO Abbreviation:  Best Pract Res Clin Haematol     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-03-05     Completed Date:  2007-05-10     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  101120659     Medline TA:  Best Pract Res Clin Haematol     Country:  England    
Other Details:
Languages:  eng     Pagination:  57-65     Citation Subset:  IM    
Affiliation:
Northwestern University Feinberg School of Medicine, Division of Hematology-Oncology, Robert H. Lurie Comprehensive Cancer Center, 676 N St. Clair Street, Suite 850, Chicago, IL 60611, USA. m-tallman@northwestern.edu
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MeSH Terms
Descriptor/Qualifier:
Aminoglycosides / therapeutic use
Antibodies, Monoclonal / therapeutic use
Antineoplastic Agents / therapeutic use*
Arsenicals / therapeutic use
Clinical Trials as Topic
Hematopoietic Stem Cell Transplantation
Humans
Leukemia, Promyelocytic, Acute / drug therapy*,  genetics
Multicenter Studies as Topic
Neoplasm Recurrence, Local / drug therapy*
Oxides / therapeutic use
Transplantation, Autologous
Transplantation, Homologous
fms-Like Tyrosine Kinase 3 / antagonists & inhibitors,  genetics
Chemical
Reg. No./Substance:
0/Aminoglycosides; 0/Antibodies, Monoclonal; 0/Antineoplastic Agents; 0/Arsenicals; 0/Oxides; 0/gemtuzumab; 1327-53-3/arsenic trioxide; EC 2.7.10.1/fms-Like Tyrosine Kinase 3

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