Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, and.
Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY.
Blood Adv. 2022 Jun 14;6(11):3433-3439. doi: 10.1182/bloodadvances.2021006682.
Frontline arsenic trioxide (ATO)-based treatment regimens achieve high rates of long-term relapse-free survival in treating acute promyelocytic leukemia (APL) and form the current standard of care. Refining prognostic estimates for newly diagnosed patients treated with ATO-containing regimens remains important in continuing to improve outcomes and identify patients who achieve suboptimal outcomes. We performed a pooled analysis of exclusively ATO-treated patients at a single academic institution and from the ALLG APML4 and Alliance C9710 studies to determine the prognostic importance of additional cytogenetic abnormalities and/or complex karyotype. We demonstrated inferior event-free survival for patients harboring complex karyotype (hazard ratio [HR], 3.74; 95% confidence interval [CI], 1.63-8.56; P = .002), but not for patients harboring additional cytogenetic abnormalities (HR, 2.13; 95% CI, 0.78-5.82; P = .142). These data support a role for full karyotypic analysis of all patients with APL and indicate a need for novel treatment strategies to overcome the adverse effect of APL harboring complex karyotype.
基于三氧化二砷（ATO）的一线治疗方案在治疗急性早幼粒细胞白血病（APL）方面取得了长期无复发生存率的高疗效，成为当前的治疗标准。在继续提高疗效和识别疗效不佳的患者方面，细化新诊断患者接受 ATO 治疗方案的预后评估仍然很重要。我们对单一学术机构和 ALLG APML4 和 Alliance C9710 研究中仅接受 ATO 治疗的患者进行了汇总分析，以确定额外细胞遗传学异常和/或复杂核型的预后意义。我们发现复杂核型患者的无事件生存（EFS）较差（风险比[HR]，3.74；95%置信区间[CI]，1.63-8.56；P =.002），但不存在额外细胞遗传学异常患者的 EFS 较差（HR，2.13；95% CI，0.78-5.82；P =.142）。这些数据支持对所有 APL 患者进行全面核型分析，并表明需要新的治疗策略来克服 APL 复杂核型的不良影响。
