Early Death and Survival of Patients With Acute Promyelocytic Leukemia in ATRA Plus Arsenic Era: A Population-Based Study
Hong‐Hu Zhu, Yafang Ma, Yu Kang, Guifang Ouyang, Wenda Luo, Renzhi Pei, Weiqun Xu, Hui-Xian Hu, Shu-Ping Mo, Xiaohua Xu, Jianping Lan, Jianping Shen, Lihong Shou, Shenxian Qian, Weiying Feng, Pu Zhao, Jinhong Jiang, Beili Hu, Jin Zhang, S. B. Qian, Gongqiang Wu, Wenping Wu, Lei Qiu, Linjie Li, Xianghua Lang, Sai Chen, Lili Chen, Junbin Guo, Lihong Cao, Huifang Jiang, Yongming Xia, Jing Le, Jianzhi Zhao, Jian Huang, Yue‐Feng Zhang, Yali Lv, Jingsheng Hua, Yong-Wei Hong, Cuiping Zheng, Juxiang Wang, Bin-Fei Hu, Xiao-Hui Chen, Liming Zhang, Shi Tao, Bingshou Xie, Yuemin Kuang, Wen-Ji Luo, Ping Su, Jun Guo, Xiao Wu, Wei Jiang, Huiqi Zhang, Yun Zhang, Chunmei Chen, Xiaofeng Xu, Yan Guo, Jin-Ming Tu, Hu Shao, Xiaoyan Yan, Yao Chen, Yinjun Lou, Jie Jin, the APL Cooperative Group of Zhejiang Province
Abstract
Most randomized trials for acute promyelocytic leukemia (APL) have investigated highly selected patients under idealized conditions, and the findings need to be validated in the real world. We conducted a population-based study of all APL patients in Zhejiang Province, China, with a total population of 82 million people, to assess the generalization of all-trans retinoic acid (ATRA) and arsenic as front-line treatment. The outcomes of APL patients were also analyzed. Between January 2015 and December 2019, 1,233 eligible patients were included in the final analysis. The rate of ATRA and arsenic as front-line treatment increased steadily from 66.2% in 2015 to 83.3% in 2019, with no difference among the size of the center (≥5 or <5 patients per year, p = 0.12) or age (≥60 or <60 years, p = 0.35). The early death (ED) rate, defined as death within 30 days after diagnosis, was 8.2%, and the 3-year overall survival (OS) was 87.9% in the whole patient population. Age (≥60 years) and white blood cell count (>10 × 10 9 /L) were independent risk factors for ED and OS in the multivariate analysis. This population-based study showed that ATRA and arsenic as front-line treatment are widely used under real-world conditions and yield a low ED rate and a high survival rate, which mimic the results from clinical trials, thereby supporting the wider application of APL guidelines in the future.