Determinants of fatal bleeding during induction therapy for acute promyelocytic leukemia in the ATRA era
Year: 2017
Type: article
Abstract: retinoic acid (ATRA) as part of induction, we assessed known determinants of bleeding at baseline and evaluated them as potential predictors of hemorrhagic death (HD) in the first 30 days of treatment. The studies included were ALLG APML3 (single arm of ATRA + idarubicin ± prednisone), ALLG APML4 (single arm of ATRA + idarubicin + arsenic trioxide + prednisone), CALGB C9710 (single arm of ATRA + cytarabine + daunorubicin), Eastern Cooperative Oncology Group-American College of Radiology Imaging Network (ECOG-ACRIN) E2491 (intergroup I0129, consisting of daunorubicin + cytarabine vs ATRA), and SWOG S0521 (single-arm induction of ATRA + cytarabine + daunorubicin). A total of 1009 patients were included in the original trials, of which 995 had sufficient data to be included in our multivariate analysis. In this final cohort, there were 37 HD cases during the first 30 days following induction, for an estimated cumulative incidence of 3.7% (95% confidence interval [CI], 2.6% to 5.0%). Using multivariate Cox proportional hazards regression, the hazard ratio of HD in the first 30 days was 2.17 (95% CI, 0.84-5.62) for an ECOG performance status of 3-4 vs 0-2 and 5.20 (95% CI, 2.70-10.02) for a white blood cell count of ≥20 000/μL vs <20 000/μL. In this large cohort of APL patients, high white blood cell count emerged as an independent predictor of early HD.
Source: Blood
Authors: Simon Mantha, Debra A. Goldman, Sean M. Devlin, Ju-Whei Lee, Diana Zannino, Marnie Collins, Dan Douer, Harry J. Iland, Mark R. Litzow, Eytan M. Stein, Frederick R. Appelbaum, Richard A. Larson, Richard Stone, Bayard L. Powell, Susan Geyer, Kristina Laumann, Jacob M. Rowe, Harry Erba, Steven Coutre, Megan Othus, Jae H. Park, Peter H. Wiernik, Martin S. Tallman
Institutions: Memorial Sloan Kettering Cancer Center, Eastern Cooperative Oncology Group, Dana-Farber Cancer Institute, Peter MacCallum Cancer Centre, Royal Prince Alfred Hospital, Mayo Clinic, Fred Hutch Cancer Center, University of Chicago, Atrium Health Wake Forest Baptist, Wake Forest Baptist Comprehensive Cancer Center, University of South Florida, Rambam Health Care Campus, University of Alabama at Birmingham, UAB Medicine, Stanford Medicine, Stanford University
Language: English
Subfield: Molecular Biology
Domain: Life Sciences
Open Access status: bronze
Awards: G1347238333, G1548551769, ECOG-ACRIN Network Group Operations Center, G1938688226, G2453551107, G3475623468, SWOG Network Group Operations Center of the NCTN, G4102770861, ECOG-ACRIN Network Group Statistics and Data Management Center, Alliance for Clinical Trials in Oncology Operations Center, G9000003249, Cancer Center Support Grant
OpenAlex ID: W2559236277