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The role of maintenance therapy in acute promyelocytic leukemia in the first complete remission

Creator:

Muchtar, E., et al

Subject Keywords: To examine the efficacy and safety of maintenance therapy in APL patients and to establish the optimal regimen for maintenance
Type: Article
Region: International (other)
Description:

Acute promyelocytic leukemia (APL) is a subtype of acute myelogenous leukemia (AML), comprising about 10% of AML cases. APL has a distinct therapeutic approach and is the most curable type of AML. It is characterized by a specific chromosome translocation, the t(15;17). The integrated effect of induction and consolidation in APL currently results in high long-term survival rates, reaching as high as 90% in some series. Contrary to the established role of initial treatment phases (termed induction and consolidation phases), in APL there is conflicting evidence regarding the place of a continued low-toxicity treatment (termed maintenance treatment) in these patients. This debate has become more intense after the introduction of all-trans retinoic acid (ATRA), which targets the PML-RARα fusion gene, and even more so with the recent addition of arsenic trioxide to the therapeutic options of APL.

The authors aimed to evaluate the effects of maintenance therapy on survival in APL patients as well as to assess its influence on other parameters, such as disease recurrence rate and adverse events. They also tried to establish the best maintenance regimen for these patients.

The authors therefore conducted a systematic review and meta-analysis of 10 randomized controlled trials including 2072 patients. The main results showed that any maintenance treatment compared to observation prolongs the freedom from disease duration but not overall survival. Similarly, ATRA and chemotherapy compared to ATRA alone improves freedom from disease duration but not overall survival. In contrast, ATRA-based regimens compared to non-ATRA based regimens do not improve freedom from disease duration nor overall survival.

Finally, They showed that any maintenance treatment compared to observation as well as maintenance combining ATRA and chemotherapy compared to ATRA alone are more toxic, potentially limiting patient adherence to treatment. Our results imply that in patients with newly diagnosed APL, ATRA-based maintenance therapy may be added to the standard therapy in order to improve freedom from disease. Yet, one should bear in mind that this treatment does not improve overall survival and adds toxicity.

 

Date:

28/03/2013

Rights: © The Cochrane Collaboration
Suggested citation:

Muchtar, E., et al. (2013) The role of maintenance therapy in acute promyelocytic leukemia in the first complete remission [Online]. Available from: http://publichealthwell.ie/node/460460 [Accessed: 26th August 2019].

  

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