Acute promyelocytic leukemia (APL) in very old patients: real-life behind protocols

Authors

  • Serena Rosati Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
  • Carmelo Gurnari Department of Biomedicine and Prevention, PhD in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, Rome, Italy; Translational Hematology and Oncology Research Department, Taussig Cancer Center, Cleveland Clinic, Cleveland, USA
  • Massimo Breccia Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
  • Ida Carmosino Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
  • Emilia Scalzulli Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
  • Enrico Montefusco Hematology, Ospedale Sant'Andrea, Rome, Italy
  • Salvatore Perrone Hematology, Polo Universitario Pontino, "Sapienza", Via A. Canova S.M. Goretti Hospital, Latina, Italy
  • Ombretta Annibali Unit of Hematology and Stem Cell Transplantation, Campus Bio-Medico University, Rome, Italy
  • Vincenza Martini UOC Ematologia, Ospedale "Fabrizio Spaziani", Frosinone, Italy
  • Giulio Trapè Hematology, Belcolle Hospital, Viterbo, Italy
  • Gioia Colafigli Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
  • Malgorzata Trawinska Hematology, Ospedale S. Eugenio, Roma, Italy
  • Clara Minotti Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
  • Giuseppe Cimino Hematology, Polo Universitario Pontino, "Sapienza", Via A. Canova S.M. Goretti Hospital, Latina, Italy
  • Agostino Tafuri Hematology Institute, La Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
  • Giuseppe Avvisati Unit of Hematology and Stem Cell Transplantation, Campus Bio-Medico University, Rome, Italy
  • Maurizio Martelli Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
  • Maria Teresa Voso Laboratorio di Neuro-Oncoematologia, Fondazione Santa Lucia, Rome, Italy;  Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
  • Roberto Latagliata Department of Translational and Precision Medicine, Sapienza University, Rome, Italy; Hematology, Belcolle Hospital, Viterbo, Italy

DOI:

https://doi.org/10.1080/0284186X.2021.1971291

Keywords:

Acute promyelocytic leukemia, all-trans retinoic acid, arsenic trioxide, elderly patients, real-life data

Abstract

Background

Acute promyelocytic leukemia (APL) is uncommon among subjects aged ≥ 70 years and the better therapeutic strategy represents an unmet clinical need.

Materials and methods

This prompted us to explore our real-life data on a retrospective cohort of 45 older APL patients (≥ 70 years) consecutively diagnosed at eight different hematologic institutions in Latium, Italy, from July 1991 to May 2019.

Results

Two patients (4.4%) died from early hemorrhagic complications before treatment could begin. Twenty-two patients (51.1%) (Group A) were enrolled or treated according to standard clinical protocols, while 21 (48.8%) (Group B) received an ATRA-based personalized approach due to poor performance status. Morphologic complete remission (CR) after induction therapy was achieved in 33 patients (76.7%) with 100% of patients in Group A and 52.3% in Group B (p < 0.001). Molecular CR was documented in 30 patients (69.7%) [20/22 (90.9%) in Group A and 10/21 (47.6%) in Group B (p = 0.002)]. Ten patients (23.2%) died during induction therapy, all in Group B. Five-year overall survival (OS) of the entire cohort was 46.1% (95% CI 28.2–64.0), with 72.6% (95% CI 42.9–100) in Group A vs. 27.2% (95% CI 7.5–46.9) in the Group B (p = 0.001).

Conclusions

The present analysis highlights that almost half of the patients received sub-optimal induction treatments and registered dismal outcomes demonstrating the importance of adopting standard therapies instead of modified or reduced personalized approaches also in the setting of frail older patients.

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Published

2021-11-02

How to Cite

Rosati, S., Gurnari, C., Breccia, M., Carmosino, I., Scalzulli, E., Montefusco, E., … Latagliata, R. (2021). Acute promyelocytic leukemia (APL) in very old patients: real-life behind protocols. Acta Oncologica, 60(11), 1520–1526. https://doi.org/10.1080/0284186X.2021.1971291

Issue

Vol. 60 No. 11 (2021): Acta Oncologica

Section

Articles