Causes and prognostic factors of remission induction failure in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and idarubicin Export

@article{citeulike:3173610, abstract = {An understanding of the prognostic factors associated with the various forms of induction mortality in patients with acute promyelocytic leukemia (APL) has remained remarkably limited. This study reports the incidence, time of occurrence, and prognostic factors of the major categories of induction failure in a series of 732 patients of all ages (range, 2-83 years) with newly diagnosed APL who received all-trans retinoic acid (ATRA) plus idarubicin as induction therapy in 2 consecutive studies of the Programa de Estudio y Tratamiento de las Hemopatias Malignas (PETHEMA) Group. Complete remission was attained in 666 patients (91\%). All the 66 induction failures were due to induction death. Hemorrhage was the most common cause of induction death (5\%), followed by infection (2.3\%) and differentiation syndrome (1.4\%). Multivariate analysis identified specific and distinct pretreatment characteristics to correlate with an increased risk of death caused by hemorrhage (abnormal creatinine level, increased peripheral blast counts, and presence of coagulopathy), infection (age >60 years, male sex, and fever at presentation), and differentiation syndrome (Eastern Cooperative Oncology Group [ECOG] score >1 and low albumin levels), respectively. These data furnish clinically relevant information that might be useful for designing more appropriately risk-adapted treatment protocols aimed at reducing the considerable problem of induction mortality in APL. 10.1182/blood-2007-07-100669}, author = {de La and Montesinos, Pau and Vellenga, Edo and Rayon, Chelo and Parody, Ricardo and Leon, Angel and Esteve, Jordi and Bergua, Juan M. and Milone, Gustavo and Deben, Guillermo and Rivas, Concha and Gonzalez, Marcos and Tormo, Mar and Diaz-Mediavilla, Joaquin and Gonzalez, Jose D. and Negri, Silvia and Amutio, Elena and Brunet, Salut and Lowenberg, Bob and Sanz, Miguel A.}, citeulike-article-id = {3173610}, citeulike-linkout-0 = {http://dx.doi.org/10.1182/blood-2007-07-100669}, citeulike-linkout-1 = {http://bloodjournal.hematologylibrary.org/cgi/content/abstract/111/7/3395}, citeulike-linkout-2 = {http://view.ncbi.nlm.nih.gov/pubmed/18195095}, citeulike-linkout-3 = {http://www.hubmed.org/display.cgi?uids=18195095}, day = {1}, doi = {10.1182/blood-2007-07-100669}, journal = {Blood}, keywords = {apl}, month = {April}, number = {7}, pages = {3395--3402}, posted-at = {2008-08-29 17:39:38}, priority = {2}, title = {Causes and prognostic factors of remission induction failure in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and idarubicin}, url = {http://dx.doi.org/10.1182/blood-2007-07-100669}, volume = {111}, year = {2008} }

TY - JOUR ID - citeulike:3173610 L3 - citeulike-article-id:3173610 N2 - An understanding of the prognostic factors associated with the various forms of induction mortality in patients with acute promyelocytic leukemia (APL) has remained remarkably limited. This study reports the incidence, time of occurrence, and prognostic factors of the major categories of induction failure in a series of 732 patients of all ages (range, 2-83 years) with newly diagnosed APL who received all-trans retinoic acid (ATRA) plus idarubicin as induction therapy in 2 consecutive studies of the Programa de Estudio y Tratamiento de las Hemopatias Malignas (PETHEMA) Group. Complete remission was attained in 666 patients (91%). All the 66 induction failures were due to induction death. Hemorrhage was the most common cause of induction death (5%), followed by infection (2.3%) and differentiation syndrome (1.4%). Multivariate analysis identified specific and distinct pretreatment characteristics to correlate with an increased risk of death caused by hemorrhage (abnormal creatinine level, increased peripheral blast counts, and presence of coagulopathy), infection (age >60 years, male sex, and fever at presentation), and differentiation syndrome (Eastern Cooperative Oncology Group [ECOG] score >1 and low albumin levels), respectively. These data furnish clinically relevant information that might be useful for designing more appropriately risk-adapted treatment protocols aimed at reducing the considerable problem of induction mortality in APL. 10.1182/blood-2007-07-100669 IS - 7 JF - Blood EP - 3402 TI - Causes and prognostic factors of remission induction failure in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and idarubicin VL - 111 SP - 3395 KW - apl AU - de La AU - Montesinos, Pau AU - Vellenga, Edo AU - Rayon, Chelo AU - Parody, Ricardo AU - Leon, Angel AU - Esteve, Jordi AU - Bergua, Juan AU - Milone, Gustavo AU - Deben, Guillermo AU - Rivas, Concha AU - Gonzalez, Marcos AU - Tormo, Mar AU - Diaz-Mediavilla, Joaquin AU - Gonzalez, Jose AU - Negri, Silvia AU - Amutio, Elena AU - Brunet, Salut AU - Lowenberg, Bob AU - Sanz, Miguel PY - 2008/04/01/ UR - http://dx.doi.org/10.1182/blood-2007-07-100669 ER -