Effect of additional cytogenetic abnormalities on survival in arsenic trioxide-treated acute promyelocytic leukemia
Zachary D. Epstein‐Peterson, Andriy Derkach, Susan M. Geyer, Krzysztof Mrózek, Jessica Kohlschmidt, Jae H. Park, Sridevi Rajeeve, Eytan M. Stein, Yanming Zhang, Harry Iland, Lynda J. Campbell, Richard A. Larson, Xavier Poiré, Bayard L. Powell, Wendy Stock, Richard M. Stone, Martin S. Tallman
Abstract
Frontline arsenic trioxide (ATO)-based treatment regimens achieve high rates of long-term relapse-free survival in treating acute promyelocytic leukemia (APL) and form the current standard of care. Refining prognostic estimates for newly diagnosed patients treated with ATO-containing regimens remains important in continuing to improve outcomes and identify patients who achieve suboptimal outcomes. We performed a pooled analysis of exclusively ATO-treated patients at a single academic institution and from the ALLG APML4 and Alliance C9710 studies to determine the prognostic importance of additional cytogenetic abnormalities and/or complex karyotype. We demonstrated inferior event-free survival for patients harboring complex karyotype (hazard ratio [HR], 3.74; 95% confidence interval [CI], 1.63-8.56; P = .002), but not for patients harboring additional cytogenetic abnormalities (HR, 2.13; 95% CI, 0.78-5.82; P = .142). These data support a role for full karyotypic analysis of all patients with APL and indicate a need for novel treatment strategies to overcome the adverse effect of APL harboring complex karyotype.