Zapata-Canto Nidia, Aguilar Manuel, Arana Luara, Montano Efren, Ramos-Penafiel Cristian, De la Pena Jose Antonio, Alvarez-Vera Jose Luis, Espitia-Rios Eugenia, Perez Zuniga Juan Manuel, Hernandez-Ruiz Eleazar, Cervera Eduardo, Espinoza-Zamora Ramiro, Sosa-Espinoza Alejandro, Solis-Poblano Juan Carlos, Demichelis Roberta, Gomez-Almaguer David, Barrera Esperanza, Mijangos Javier, Solis-Armenta Ruben, de Jesus Perez Oscar, Herrera Miguel, Diaz-Vargas Guillermo, Cabrera-Garcia Alvaro, Flores-Jimenez Juan Antonio, Morales-Adrian Javier, Ramirez-Romero Eva Fabiola, Ceballos-Lopez Adrian, Guillermo Victor Antonio, Manuel Manuel Solano, Lourdes Esthela Juan Lien-Chang, Ojeda-Tovar Juan, Gomez-Perdomo Gladys, Alvarado-Ibarra Martha
Instituto Nacional de Cancerologia, Ciudad de Mexico, Mexico.
Hospital 20 de Noviembre ISSSTE, Ciudad de Mexico, Mexico.
J Hematol. 2021 Apr;10(2):53-63. doi: 10.14740/jh773. Epub 2021 Apr 27.
The present retrospective study reviewed acute promyelocytic leukemia (APL) cases recorded in Mexico between January 2007 and January 2017. The primary objective of the study was to evaluate overall survival (OS) in Mexican patients with APL. Secondary objective was to evaluate the impact of induction treatment with different anthracyclines on OS, event-free survival (EFS) and complications in this patient population.
The medical charts of patients referred to medical institutions in Mexico from January 2007 through January 2017 for the treatment of suspected APL were reviewed retrospectively. Patients aged 15 - 75 years, in whom the diagnosis of APL was confirmed, who had an Eastern Cooperative Group performance status of 0 - 2, and who were eligible for combined treatment with intensive chemotherapy and all-trans retinoic acid (ATRA), were included in the study. Study participants received induction and consolidation treatment with ATRA plus either daunorubicin or idarubicin, followed by 2 years of single-agent ATRA as maintenance therapy. Patients who were unable to pay for ATRA treatment received anthracycline-based induction and consolidation, with methotrexate plus mercaptopurine as maintenance therapy.
A total of 360 patients from 21 public and private hospitals were included in the study. The median age of the population was 37 years, and 51% were male. Of the 360 patients, 205 (57%) vs. 155 (43%) received daunorubicin vs. idarubicin as induction treatment for APL. ATRA was administered to 201 (98%) patients in the daunorubicin group vs. 138 (89%) in the idarubicin group (P = 0.001), and was initiated at diagnosis in 92% vs. 73% of recipients, respectively (P = 0.0001). At 150 months, OS and EFS for the entire population were 84% and 79%, respectively. Both OS (90% vs. 76%, P = 0.003) and EFS (85% vs. 72%, P = 0.001) were significantly prolonged in daunorubicin vs. idarubicin recipients. Rates of complications were similar in the two groups.
As arsenic trioxide (ATO) is not currently available in Mexico, anthracycline plus ATRA is the mainstay of treatment for APL here. Our results confirm the efficacy of this strategy, with high OS and EFS rates being observed 12.5 years after diagnosis.
本回顾性研究对2007年1月至2017年1月期间墨西哥记录的急性早幼粒细胞白血病（APL）病例进行了回顾。该研究的主要目的是评估墨西哥APL患者的总生存期（OS）。次要目的是评估不同蒽环类药物诱导治疗对该患者群体的OS、无事件生存期（EFS）和并发症的影响。
回顾性分析了2007年1月至2017年1月期间转诊至墨西哥医疗机构治疗疑似APL的患者的病历。纳入研究的患者年龄在15 - 75岁之间，APL诊断得到证实，东部肿瘤协作组体能状态为0 - 2，且符合强化化疗和全反式维甲酸（ATRA）联合治疗条件。研究参与者接受ATRA联合柔红霉素或伊达比星的诱导和巩固治疗，随后2年采用单药ATRA作为维持治疗。无法支付ATRA治疗费用的患者接受以蒽环类药物为基础的诱导和巩固治疗，以甲氨蝶呤加巯嘌呤作为维持治疗。
来自21家公立和私立医院的360例患者纳入研究。人群中位年龄为37岁，51%为男性。在360例患者中，205例（57%）与155例（43%）接受柔红霉素与伊达比星作为APL的诱导治疗。柔红霉素组201例（98%）患者接受了ATRA，伊达比星组为138例（89%）（P = 0.001），分别有92%和73%的接受者在诊断时开始使用ATRA（P = 0.0001）。在150个月时，整个人群的OS和EFS分别为84%和79%。柔红霉素接受者的OS（90%对76%，P = 0.003）和EFS（85%对72%，P = 0.001）均显著延长。两组并发症发生率相似。
由于墨西哥目前没有三氧化二砷（ATO），蒽环类药物加ATRA是该国APL的主要治疗方法。我们的结果证实了该策略的有效性，在诊断后12.5年观察到高OS和EFS率。
