The impact of medical education and networking on the outcome of leukemia treatment in developing countries. The experience of International Consortium on Acute Promyelocytic Leukemia (IC-APL)
Year: 2012
Type: article
Study design: Clinical Trial
Abstract: OBJECTIVES: Several clinical trials conducted in Europe and US reported favorable outcomes of patients with APL treated with the combination of all trans retinoic acid (ATRA) and anthracyclines. Nevertheless, the results observed in developing countries with the same regimen was poorer, mainly due to high early mortality mainly due bleeding. The International Consortium on Acute Promyelocytic Leukemia (IC-APL) is an initiative of the International Members Committee of the ASH and the project aims to reduce this gap through the establishment of international network, which was launched in Brazil, Mexico and Uruguay. METHODS: The IC-APL treatment protocol is similar to the PETHEMA 2005, but changing idarubicin to daunorubicin. All patients with a suspected diagnosis of APL were immediately started on ATRA, while bone marrow samples were shipped to a national central lab where genetic verification of the diagnosis was performed. The immunofluorescence using an anti-PML antibody allowed a rapid confirmation of the diagnosis and, the importance of supportive measures was reinforced. RESULTS: The interim analysis of 97 patients enrolled in the IC-APL protocol showed that complete remission (CR) rate was 83% and the 2-year overall survival and disease-free survival were 80% and 90%, respectively. Of note, the early mortality rate was reduced to 7.5%. DISCUSSION: The results of IC-APL demonstrate the impact of educational programs and networking on the improvement of the leukemia treatment outcome in developing countries.
Source: Hematology
Authors: Eduardo M Rego, Haesook T Kim, Guillermo J Ruiz-Argüelles, Maria del Rosario Uriarte, Rafael H Jacomo, Homero Gutiérrez-Aguirre, Raul A M Melo, Rosane Bittencourt, Ricardo Pasquini, Katia Pagnano, Evandro M Fagundes, Maria de Lourdes Chauffaille, Carlos Chiattone, Lem Martinez, Luis A Meillón, David Gómez-Almaguer, Hau Kwaan, Javier Garcés-Eisele, Robert Gallagher, Charlotte M Niemeyer, Bob Lowenberg, Raul Ribeiro, Francesco LoCoco, Miguel A Sanz
Institutions: Universidade de São Paulo, Dana-Farber Cancer Institute, Clínica Ruiz, Hospital Universitario Dr José Eleuterio Gonzalez, Universidade Federal do Rio Grande do Sul, Universidade Federal do Paraná, Universidade Estadual de Campinas (UNICAMP), Universidade Federal de Minas Gerais, Universidade Federal de São Paulo, Centro Medico Nacional Siglo XXI, Northwestern University, Albert Einstein College of Medicine, Montefiore Einstein Comprehensive Cancer Center, University of Freiburg, University Medical Center Freiburg, Erasmus MC, St. Jude Children's Research Hospital, University of Rome Tor Vergata, Hospital Universitari i Politècnic La Fe
Language: English
Subfield: Molecular Biology
Domain: Life Sciences
Open Access status: bronze
OpenAlex ID: W2090796175