All-Trans Retinoic Acid and Arsenic Trioxide With or Without Gemtuzumab Ozogamicin and Idarubicin Highly Effective for Treating Relapsed Acute Promyelocytic Leukemia

The combination of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) with or without gemtuzumab ozogamicin and idarubicin is a highly effective salvage therapy for treating patients with relapsed acute promyelocytic leukemia, according to a recent study.

Investigators reviewed 61 participants with relapsed acute promyelocytic leukemia who were treated from November 1991 to June 2023. Over the course of the study, 31 patients (51%) received modern therapy with the combination of ATRA and ATO, with or without idarubicin and gemtuzumab ozogamicin. Overall, 56 patients (92%) achieved complete response (CR) after the first salvage therapy. Additionally, 20 patients received a form of stem cell transplantation (SCT), with 10 receiving autologous SCT and 10 receiving allogeneic SCT.

Results demonstrated, with a median follow-up time of 138 months, the median survival durations were 32 months and 164 months with historical therapy vs modern (ATRA-ATO) therapy (P = .035). It was noted that the 5-year survival rates were 44% vs 71%, respectively. Furthermore, with a 10-month landmark analysis, the median survival durations were 102 months vs not reached; the 5-year survival rates were 57% and 70% without SCT vs with SCT (P = .193). 

Concluding data demonstrated the survival benefit with SCT was more prominent in the historical therapy era. However, it was noted that the patients who received the modern combination therapy of ATRA-ATO with and without idarubicin and gemtuzumab ozogamicin had similar outcomes without vs with SCT (P = .848).

Koji Sasaki, MD, PhD, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, and colleagues concluded, “The combination of ATRA-ATO ([with or without] [gemtuzumab ozogamicin] and idarubicin) is a highly effective salvage therapy in relapsed [acute promyelocytic leukemia].”

“The use of [stem cell transplantation] may not be needed after first relapse-second remission but may be considered in subsequent relapses,” they added.

Source:

Sasaki K, Ravandi F, Kadia T, et al. Outcome of patients with relapsed acute promyelocytic leukemia. Clinical Lymphoma, Myeloma, & Leukemia. Published online Feb 3, 2024. doi: 10.1016/j.clml.2024.01.015