Acute Promyelocytic Leukemia Asian Consortium study of arsenic trioxide in newly-diagnosed patients: impact and outcome

• Published in: Blood advances 2024-12
• Main Authors: Gill, Harinder, Raghupathy, Radha, Hou, Hsin-An, Cheng-Hong Tsai, Xavier, Tantiworawit, Adisak, Ooi, Melissa G., Gan, Gin-Gin, Wong, Chieh-Lee, Yim, Rita, Chin, Lynn, Lee, Paul, Li, Vivian W.K., Au, Lester, Zhang, Qi, Leung, Garret M.K., Wu, Tony K.Y., Lee, Carmen Y.Y., Chng, Wee-Joo, Tien, Hwei-Fang, Kumana, Cyrus R., Kwong, Yok-Lam
• Format: Article
• Language: English
• ISSN: 2473-9529; 2473-9537; 2473-9537
• DOI: 10.1182/bloodadvances.2024014999

•In APL, frontline oral or intravenous arsenic trioxide (ATO) reduced early deaths and improved RFS and OS, independent of risk category.•Without frontline ATO, inferior RFS could still be mitigated by using an oral-ATO-based regimen in maintenance. The Acute Promyelocytic Leukemia Asian Consortium analyzed a contemporaneous cohort of newly-diagnosed APL patients treated with and without frontline arsenic trioxide (ATO) in six centers. The objectives were to define the impact of ATO on early deaths and relapses, and its optimal positioning in the overall treatment strategy. In a 21.5-year period, 324 males and 323 females at a median age of 45.5 (range: 18.1-91.8) years (low/intermediate risk, N=448; high-risk, N=199) were treated. Regimens included frontline all-trans retinoic acid (ATRA)/chemotherapy and maintenance with/without ATO (N=436); ATRA/intravenous-ATO/chemotherapy (ATRA/i.v.-ATO; N=61); and ATRA/oral-ATO/ascorbic acid with ATO maintenance (oral-AAA; N=150). The ATRA/chemotherapy group, compared with the ATO-containing (ATRA/i.v.-ATO and oral-AAA) groups, had significantly more frequent early deaths within 60 days (8.3% versus 3.3%; P=0.05); inferior 60-day survival (91.7% versus 98.4%/96%; P