학술논문
Acute promyelocytic leukemia (APL) in very old patients: real-life behind protocols.
Document Type
Article
Author
Rosati, Serena; Gurnari, Carmelo; Breccia, Massimo; Carmosino, Ida; Scalzulli, Emilia; Montefusco, Enrico; Perrone, Salvatore; Annibali, Ombretta; Martini, Vincenza; Trapè, Giulio; Colafigli, Gioia; Trawinska, Malgorzata; Minotti, Clara; Cimino, Giuseppe; Tafuri, Agostino; Avvisati, Giuseppe; Martelli, Maurizio; Voso, Maria Teresa; Latagliata, Roberto
Source
Subject
*HEMORRHAGE risk factors
*TREATMENT of acute promyelocytic leukemia
*THERAPEUTICS
*CONFIDENCE intervals
*RETROSPECTIVE studies
*TREATMENT effectiveness
*COMPARATIVE studies
*ACUTE promyelocytic leukemia
*SURVIVAL analysis (Biometry)
*DESCRIPTIVE statistics
*MEDICAL needs assessment
*LONGITUDINAL method
*DISEASE remission
*DISEASE complications
*OLD age
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Language
ISSN
0284-186X
Abstract
Acute promyelocytic leukemia (APL) is uncommon among subjects aged ≥ 70 years and the better therapeutic strategy represents an unmet clinical need. This prompted us to explore our real-life data on a retrospective cohort of 45 older APL patients (≥ 70 years) consecutively diagnosed at eight different hematologic institutions in Latium, Italy, from July 1991 to May 2019. Two patients (4.4%) died from early hemorrhagic complications before treatment could begin. Twenty-two patients (51.1%) (Group A) were enrolled or treated according to standard clinical protocols, while 21 (48.8%) (Group B) received an ATRA-based personalized approach due to poor performance status. Morphologic complete remission (CR) after induction therapy was achieved in 33 patients (76.7%) with 100% of patients in Group A and 52.3% in Group B (p < 0.001). Molecular CR was documented in 30 patients (69.7%) [20/22 (90.9%) in Group A and 10/21 (47.6%) in Group B (p = 0.002)]. Ten patients (23.2%) died during induction therapy, all in Group B. Five-year overall survival (OS) of the entire cohort was 46.1% (95% CI 28.2–64.0), with 72.6% (95% CI 42.9–100) in Group A vs. 27.2% (95% CI 7.5–46.9) in the Group B (p = 0.001). The present analysis highlights that almost half of the patients received sub-optimal induction treatments and registered dismal outcomes demonstrating the importance of adopting standard therapies instead of modified or reduced personalized approaches also in the setting of frail older patients. [ABSTRACT FROM AUTHOR]