Elderly with Acute Promyelocytic Leukemia Achieve Long-Term Survival with Treatment

Elderly with Acute Promyelocytic Leukemia Achieve Long-Term Survival with Treatment

According to results published in a recent advanced online article in the journal Blood, long-term cancer-free survival can be achieved with treatment consisting of an anthracycline and ATRA for elderly patients with acute promyelocytic leukemia.

Acute promyelocytic leukemia (APL) is a subset of acute myeloid leukemia (AML), a fast-growing cancer of the blood cells. APL is not a common type of cancer, affecting approximately 1,500 individuals annually in the United States. Blood cells can be divided into 3 general categories: white blood cells, which fight infection; red blood cells, which transport oxygen to cells; and platelets, which aid in blood clotting. APL is a cancer of the white blood cells (immune cells) in which the cells remain in an immature state and continue to replicate uncontrollably. The immature blood cells are not able to perform their intended function of fighting infection and they suppress the maturation of other blood cells in the body. Standard initial treatment for APL consists of chemotherapy, including an anthracycline (doxorubicin, epirubicin, mitoxantrone, idarubicin) and the agent all trans-retinoic acid (ATRA).

Physicians are often concerned with the ability of elderly patients to tolerate standard treatment approaches in various types of cancer. It is perceived that the elderly may be too frail and/or have additional medical conditions that may inhibit their tolerance to therapy. This perception often leaves this group of patients to receive lower doses of treatment or different treatment regimens than their younger counterparts. More recently, results from clinical trials have demonstrated that medically fit elderly patients actually achieve the same benefit as younger patients from standard treatment in several types of cancer, and these results are beginning to affect the clinical management of the elderly.

Researchers from Spain recently conducted a clinical trial to evaluate the treatment combination of an anthracycline plus ATRA in the treatment of 104 patients with APL ranging in age from 60-70 years, with an average age of 68. Patients were treated with a regimen consisting of ATRA plus the anthracyclines idarubicin and mitoxantrone. Six years following diagnosis, nearly 80% of patients in this trial were alive and cancer free. At 6 years, the cancer recurrence rate was 8.5%, which is better than those typically observed in younger patients undergoing this treatment regimen.

The researchers concluded that treatment with ATRA plus anthracyclines in elderly patients with APL results in excellent cancer-free survival at 6 years and is generally well tolerated in this patient population. Elderly patients with APL may wish to speak with their physician about the risks and benefits of treatment with ATRA and anthracyclines.

Reference: Sanz, MA, Vellenga E, Rayon C, et al. All-trans retinoic acid and anthracycline monochemotherapy for the treatment of elderly patients with acute promyelocytic leukemia. Blood. First Edition Paper, pre-published online August 3, 2004; DOI 10.1182/blood-2004-04-1642.

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