Oral arsenic trioxide-based maintenance regimens for first complete remission of acute promyelocytic leukemia: A 10-year follow-up study

Abstract

Seventy-six patients with acute promyelocytic leukemia (APL) in first complete remission after induction and consolidation by daunorubicin and cytosine arabinoside received oral arsenic trioxide (As 2O 3)-based maintenance. Three regimens were used: oral As 2O 3 (10 mg/day, regimen A, n ∇ 20), oral As 2O 3 plus all-trans retinoic acid (ATRA, 45 mg/m 2 per day, regimen AA, n ∇ 19), and oral As 2O 3plus ATRA plus ascorbic acid (1000 mg/day, regimen AAA, n ∇ 37), each given for 2 weeks every 2 months for 2 years. Patients receiving A, AA, and AAA maintenance did not differ significantly in clinicopathologic features and risk factors. Headache, dyspepsia, reversible liver function derangement, and herpes zoster reactivation were adverse effects observed during maintenance. QTc prolongation and arrhythmias were not encountered. At a median follow-up of 24 months (range, 1-115 months), there were 8 relapses. The 3-year leukemia-free-survival, event-free-survival, and overall-survival were 87.7%, 83.7%, and 90.6%, respectively. Adverse prognostic factors included male gender for leukemia-free-survival, and unrelated cancers for overall survival. Age, presentation WBC count and platelet count, and the type of oral As 2O 3 maintenance regimens had no impact on survivals. Prolonged oral As 2O 3 maintenance was feasible and safe and resulted in favorable outcomes when used with a simple induction and consolidation regimen compared with other protocols composed of multiple chemotherapeutic agents. © 2011 by The American Society of Hematology.