A complete oral regimen for induction therapy of patients with high‐risk APL: An oral etoposide instead of intravenous infusion for cytoreductive chemotherapy

Summary There is an urgent need for an oral, efficient and safe regimen for high‐risk APL under the pandemic of COVID‐19. We retrospectively analysed 60 high‐risk APL patients. For induction therapy (IT), in addition to all‐trans retinoic acid (ATRA) and oral arsenic (RIF), 22 patients received oral...

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Published in:British journal of haematology 2024-08, Vol.205 (2), p.510-516
Main Authors: Tang, Fei‐Fei, Duan, Wen‐Bing, Liu, Xiao‐Hong, Lu, Sheng‐Ye, Zhao, Xiao‐Su, Qin, Ya‐Zhen, Jia, Jin‐Song, Wang, Jing, Gong, Li‐Zhong, Jiang, Qian, Zhao, Ting, Shi, Hong‐Xia, Chang, Ying‐Jun, Huang, Xiao‐Jun, Jiang, Hao
Format: Article
Language:English
Subjects:
acute promyelocytic leukaemia
Arsenic
Chemotherapy
completely oral
COVID-19
Cytotoxicity
Etoposide
Induction therapy
Intravenous administration
Remission
Retinoic acid
Survival
VP16 protein
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Summary:Summary There is an urgent need for an oral, efficient and safe regimen for high‐risk APL under the pandemic of COVID‐19. We retrospectively analysed 60 high‐risk APL patients. For induction therapy (IT), in addition to all‐trans retinoic acid (ATRA) and oral arsenic (RIF), 22 patients received oral etoposide (VP16) as cytotoxic chemotherapy (CC), and 38 patients received intravenous CC as historical control group. The median dose of oral VP16 was 1000 mg [interquartile rage (IQR), 650–1250]. One patient died during IT in the control group, 59 evaluable patients (100%) achieved complete haematological remission (CHR) after IT and complete molecular remission (CMR) after consolidation therapy. The median time to CHR and CMR was 36 days (33.8–44) versus 35 days (32–42; p = 0.75) and 3 months (0.8–3.5) versus 3.3 months (2.4–3.7; p = 0.58) in the oral VP16 group and in the control group. Two (9.1%) and 3 (7.9%) patients experienced molecular relapse in different group respectively. The 2‐year estimated overall survival and event‐free survival were 100% versus 94.7% (p = 0.37) and 90.9% versus 89.5% (p = 0.97) respectively. A completely oral, efficient and safe induction regimen including oral VP16 as cytoreductive chemotherapy combined with ATRA and RIF is more convenient to administer for patients with high‐risk APL. Under the pandemic of COVID‐19, an oral, efficient and safe regimen for high‐risk acute promyelocytic leukaemia (APL) induction therapy is an urgent need. For induction therapy, in addition to all‐trans retinoic acid (ATRA) and oral arsenic (RIF), high‐risk APL was retrospectively analysed by dividing into two cytoreductive groups: the oral etoposide group (the completely oral group) and the intravenous cytoreductive group. The rate of complete haematological remission (CHR), complete molecular remission (CMR) and molecular relapse did not differ between the two groups. The 2‐year overall survival (OS) and 2‐year event‐free survival (EFS) were comparable. Moreover, the completely oral group manifested the same safety as intravenous cytoreductive group.
ISSN:0007-1048
1365-2141
1365-2141
DOI:10.1111/bjh.19464