Acute Promyelocytic Leukemia (APL) in Very Elderly Patients: Real-Life behind Protocols

• Published in: Blood 2019-11, Vol.134 (Supplement_1), p.3845-3845
• Main Authors: Rosati, Serena, Breccia, Massimo, Gurnari, Carmelo, Carmosino, Ida, Scalzulli, Emilia, Montefusco, Enrico, Perrone, Salvatore, Annibali, Ombretta, Martini, Vincenza, Trapè, Giulio, Trawinska, Malgorzata Monika, Minotti, Clara, Cimino, Giuseppe, Tafuri, Agostino, Avvisati, Giuseppe, Voso, Maria Teresa, Foà, Robin, Latagliata, Roberto
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2019-129216

Introduction APL in the elderly is rare and about 5% of patients with APL are older than 70 years at diagnosis; compared to young adults, prognosis of older patients with APL remains poorer, due to the presence of severe comorbidities and the higher rate of mortality related to induction or consolidation therapy. Aim To evaluate in an unselected real-life cohort of APL patients aged ≥ 70 years the true efficacy of targeted treatments and follow-up of disease. Methods A retrospective cohort of 45 consecutive APL patients (M/F 27/18), aged ≥ 70 years and diagnosed at 8 different hematologic institutions in Lazio, Italy, from July 1991 to May 2019 was analyzed. To avoid possible selection bias, particular attention was given to consider also patients managed outside of clinical trials because of comorbidities at diagnosis and patients dead immediately after APL diagnosis before starting any treatment. Results The median age at diagnosis was 76.6 years (range 70 - 87.1). The main clinical features at diagnosis are shown in Table 1. As to major comorbidities, 28 patients(62.2%) had concomitant cardiologic diseases, 13 (28.8%) had a clinical history of cancer and 11 (24.4%) were affected by diabetes. Forty-three patients (95.5%) started therapy after diagnosis, 2 (4.4%) died before starting treatment from early hemorrhagic complications. Twenty-two patients (51.1%) (Group A) were enrolled in clinical controlled trials or were treated according to clinical controlled trials [13 pts (59.0%) according to AIDA-like regimen, 9 (40.9%) according to APL0406 study], while 21 patients (48,8%) (Group B) received an ATRA-based personalized approach. Overall, complete morphologic remission (CR) after induction therapy was achieved in 33 patients (76.7%); all patients in the Group A achieved CR compared to 11 patients (52.3%) in the Group B (p