Comparison of treatment regimens and outcomes for representative contemporary protocolsa
| Reference . | No. (age restriction) . | Median followup, y . | No. of arsenic treatment daysb . | Idarubicin equivalent, mg/m2c . | Cytarabine, g/m2b . | Other cytotoxic agents in induction and/or consolidation . | OSd . | DFSd . | EFSd . |
|---|---|---|---|---|---|---|---|---|---|
| Adès (APL 2000)28 | 178 (< 65) | 5.2 | 99 | 10.8-22.8e | 94% (3 y) | 86% (3 y) | |||
| Sanz (LPA 2005)3 | 402 | 2.3 | 105-125e | 0-5.8e | 88% (4 y) | 90% (4 y) | |||
| Lo Coco (AIDA 2000)4 | 445 (< 62) | 4.9 | 121.7 | 0-6.3e | Etoposidef 6-thioguaninef | 87% (6 y) | 86% (6 y) | ||
| Matthews (Vellore)9 | 72 | 5.0 | 112-158 | Hydroxyureag Low-dose anthracyclineg | 74% (5 y) | 80% (5 y) | 69% (5 y) | ||
| Ghavamzadeh (Tehran)10 | 197 | 3.2 (patients in CR) | 58-142h | Hydroxyureag | 64% (5 y) | 67% (5 y) | |||
| Lu (Beijing)22 i | 19 | 1.1 | 546-597 | 77% (3 y) | |||||
| Powell (North American Intergroup C9710)13 | 243 | 2.4 | 50 | 100 | 1.4 | Hydroxyureag | 86% (3 y) | 90% (3 y) | 80% (3 y) |
| Gore (Baltimore)25 | 45 | 2.7 | 30 | 72 | 2.0 | Hydroxyureag | 88% (3 y) | 89% (3 y) | 76% (3 y) |
| Hu (Shanghai)11 | 85 | 5.8 | 175 | 81 | 17.7-26.7e | Hydroxyureag Idarubicin + cytarabineg Homoharringtoninej | 92% (5 y) | 95% (5 y)k | 89% (5 y) |
| Dai (Changsha)26 j | 90 | 2.7 | 68-84 | 135 | 2.6-3.6e | Hydroxyureag Homoharringtonineg,j | 93% (2.5 y) | ||
| Ravandi (Houston)12 | 82 | 1.9 | 99-110h | Gemtuzumab ozogamicing | 85% (3 y) | 81% (3 y)m | |||
| Iland APML4 (current study) | 124 | 2.0 | 81 | 48 | 93% (2 y) | 98% (2 y) | 88% (2 y) |
| Reference . | No. (age restriction) . | Median followup, y . | No. of arsenic treatment daysb . | Idarubicin equivalent, mg/m2c . | Cytarabine, g/m2b . | Other cytotoxic agents in induction and/or consolidation . | OSd . | DFSd . | EFSd . |
|---|---|---|---|---|---|---|---|---|---|
| Adès (APL 2000)28 | 178 (< 65) | 5.2 | 99 | 10.8-22.8e | 94% (3 y) | 86% (3 y) | |||
| Sanz (LPA 2005)3 | 402 | 2.3 | 105-125e | 0-5.8e | 88% (4 y) | 90% (4 y) | |||
| Lo Coco (AIDA 2000)4 | 445 (< 62) | 4.9 | 121.7 | 0-6.3e | Etoposidef 6-thioguaninef | 87% (6 y) | 86% (6 y) | ||
| Matthews (Vellore)9 | 72 | 5.0 | 112-158 | Hydroxyureag Low-dose anthracyclineg | 74% (5 y) | 80% (5 y) | 69% (5 y) | ||
| Ghavamzadeh (Tehran)10 | 197 | 3.2 (patients in CR) | 58-142h | Hydroxyureag | 64% (5 y) | 67% (5 y) | |||
| Lu (Beijing)22 i | 19 | 1.1 | 546-597 | 77% (3 y) | |||||
| Powell (North American Intergroup C9710)13 | 243 | 2.4 | 50 | 100 | 1.4 | Hydroxyureag | 86% (3 y) | 90% (3 y) | 80% (3 y) |
| Gore (Baltimore)25 | 45 | 2.7 | 30 | 72 | 2.0 | Hydroxyureag | 88% (3 y) | 89% (3 y) | 76% (3 y) |
| Hu (Shanghai)11 | 85 | 5.8 | 175 | 81 | 17.7-26.7e | Hydroxyureag Idarubicin + cytarabineg Homoharringtoninej | 92% (5 y) | 95% (5 y)k | 89% (5 y) |
| Dai (Changsha)26 j | 90 | 2.7 | 68-84 | 135 | 2.6-3.6e | Hydroxyureag Homoharringtonineg,j | 93% (2.5 y) | ||
| Ravandi (Houston)12 | 82 | 1.9 | 99-110h | Gemtuzumab ozogamicing | 85% (3 y) | 81% (3 y)m | |||
| Iland APML4 (current study) | 124 | 2.0 | 81 | 48 | 93% (2 y) | 98% (2 y) | 88% (2 y) |
References 3, 4, and 28 are ATRA/chemotherapy protocols; references 9, 10, and 22 are single-agent arsenic protocols (ATO or As4S4); references 13 and 25 are ATRA/chemotherapy protocols with ATO in consolidation; references 11 and 26 are ATRA/ATO/chemotherapy protocols; and reference 12 is an ATRA/ATO protocol with gemtuzumab ozogamicin for high-risk patients.
Data for arsenic exposure (ATO or As4S4) include amounts used in induction, consolidation, and (where appropriate) maintenance; data for idarubicin equivalent and cytarabine doses include amounts used in induction and consolidation.
Idarubicin equivalent calculated as follows41 : 10 mg of idarubicin = 12 mg of mitoxantrone = 50 mg of daunorubicin.
OS: overall survival; DFS: disease-free survival; EFS: event-free survival; survival data are single time-point figures at the times shown in parentheses.
Higher dose for high-risk patients, except LPA 2005, in which the intermediate-risk group received the highest idarubicin equivalent dose of anthracycline (idarubicin) plus anthraquinone (mitoxantrone).
Additional chemotherapy during consolidation for high-risk patients.
Additional chemotherapy during induction for high-risk patients.
Based on median number of days to CR = 30.
This study used single-agent As4S4 rather than ATO.
Additional chemotherapy during consolidation for all patients.
Data were reported as RFS with no deaths in CR and are therefore included as DFS here.
Results shown are for the group B1 patients who received ATRA and ATO during induction; the total cytarabine dose ranged from 4.5-6.3 g and has been adjusted for an average body surface area of 1.73 m2.
EFS in this series was measured from the date of CR until relapse or death and is therefore listed here as DFS.