Rego Eduardo M, Kim Haesook T, Ruiz-Argüelles Guillermo J, Uriarte Maria del Rosario, Jacomo Rafael H, Gutiérrez-Aguirre Homero, Melo Raul A M, Bittencourt Rosane, Pasquini Ricardo, Pagnano Katia, Fagundes Evandro M, Chauffaille Maria de Lourdes, Chiattone Carlos, Martinez Lem, Meillón Luis A, Gómez-Almaguer David, Kwaan Hau, Garcés-Eisele Javier, Gallagher Robert, Niemeyer Charlotte M, Lowenberg Bob, Ribeiro Raul, LoCoco Francesco, Sanz Miguel A
Hematology Service, Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
Hematology. 2012 Apr;17 Suppl 1:S36-8. doi: 10.1179/102453312X13336169155376.
Several clinical trials conducted in Europe and US reported favorable outcomes of patients with APL treated with the combination of all trans retinoic acid (ATRA) and anthracyclines. Nevertheless, the results observed in developing countries with the same regimen was poorer, mainly due to high early mortality mainly due bleeding. The International Consortium on Acute Promyelocytic Leukemia (IC-APL) is an initiative of the International Members Committee of the ASH and the project aims to reduce this gap through the establishment of international network, which was launched in Brazil, Mexico and Uruguay.
The IC-APL treatment protocol is similar to the PETHEMA 2005, but changing idarubicin to daunorubicin. All patients with a suspected diagnosis of APL were immediately started on ATRA, while bone marrow samples were shipped to a national central lab where genetic verification of the diagnosis was performed. The immunofluorescence using an anti-PML antibody allowed a rapid confirmation of the diagnosis and, the importance of supportive measures was reinforced.
The interim analysis of 97 patients enrolled in the IC-APL protocol showed that complete remission (CR) rate was 83% and the 2-year overall survival and disease-free survival were 80% and 90%, respectively. Of note, the early mortality rate was reduced to 7.5%.
The results of IC-APL demonstrate the impact of educational programs and networking on the improvement of the leukemia treatment outcome in developing countries.
在欧洲和美国进行的多项临床试验报告了接受全反式维甲酸（ATRA）和蒽环类药物联合治疗的急性早幼粒细胞白血病（APL）患者取得了良好疗效。然而，在发展中国家采用相同方案观察到的结果较差，主要原因是早期死亡率高，主要是出血所致。国际急性早幼粒细胞白血病联盟（IC - APL）是美国血液学会国际成员委员会发起的一项倡议，该项目旨在通过建立国际网络来缩小这一差距，该网络已在巴西、墨西哥和乌拉圭启动。
IC - APL治疗方案与PETHEMA 2005方案相似，但将伊达比星换成柔红霉素。所有疑似诊断为APL的患者立即开始接受ATRA治疗，同时将骨髓样本送往国家中央实验室进行诊断的基因验证。使用抗PML抗体的免疫荧光法可快速确诊，同时强化了支持措施的重要性。
对纳入IC - APL方案的97例患者的中期分析显示，完全缓解（CR）率为83%，2年总生存率和无病生存率分别为80%和90%。值得注意的是，早期死亡率降至7.5%。
IC - APL的结果证明了教育项目和网络建设对改善发展中国家白血病治疗结果的影响。
