All-transretinoic acid and chemotherapy in the treatment of acute promyelocytic leukemia

BACKGROUND: All- transretinoic acid (ATRA) and chemotherapy has improved complete remission rates and disease free survival in acute promyelocytic leukemia (APL). There is scanty data from Middle East.
AIM: To determine the efficacy of ATRA and multi-agent combination chemotherapy in treatment of APL in a single Centre in Kuwait.
SET-UPS AND DESIGN: Tertiary cancer centre, retrospective study.
METHODS AND MATERIAL: All newly diagnosed APL patients were treated with oral ATRA 45mg/m² daily until complete remission (CR), intravenous daunorubicin 50mg/m² on days 1,3 and 5, cytosine arabinoside 100mg/m² 12hrly on days 1 through 10 and etoposide 100mg/m² on days 1 through 5. Post remission three courses of intensive consolidation chemotherapy were administered. Since October 1999, maintenance chemotherapy consisting of oral 6 mercaptopurine 90mg/m² daily, methotrexate 15mg/m² weekly and ATRA 45mg/m² for 2 weeks every three months was added. Complete remission rates and duration, relapse rate and toxicity were studied. RESULTS: 22 of 24 evaluable patients (91.6%) achieved CR. The median duration of remission was 13 months (range 2-55 months). Three patients (12.5%) relapsed. Two patients (8.3%) developed retinoic acid syndrome and responded to dexamethasone. Five patients (20.8%) died one each of refractory disease, during remission induction and of relapse. Two patients died while in remission. CONCLUSION:: ATRA and combination chemotherapy results in high complete remission rates and low relapse rate in newly diagnosed APL. Maintenance therapy may be useful in preventing relapses.

Keywords
Acute Promyelocytic Leukemia, All-transretinoic acid, Chemotherapy, Kuwait