Walking a Tightrope: Dosage Modifications and Treatment Outcomes of All-Trans-Retinoic Acid, Arsenic Trioxide, and Daunorubicin for High-Risk Acute Promyelocytic Leukemia
PURPOSEThe use of all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO) in the treatment of low- and intermediate-risk acute promyelocytic leukemia (APL) is the standard of care. We report the combined use of ATRA, ATO, and daunorubicin (DNR) in patients newly diagnosed with high-risk APL. The p...
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| Format: | Article |
| Language: | English |
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American Society of Clinical Oncology
2020-11-01
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| Series: | JCO Global Oncology |
| Online Access: | https://ascopubs.org/doi/10.1200/GO.20.00226 |
| _version_ | 1818759819370168320 |
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| author | Madhav Danthala Krishna Reddy Golamari Arun Seshachalam Anupama Mikkilineni Sitalata Chappidi Mahesh Babu Mekala Vidhubala Elangovan Palanivel Chinnakali |
| author_facet | Madhav Danthala Krishna Reddy Golamari Arun Seshachalam Anupama Mikkilineni Sitalata Chappidi Mahesh Babu Mekala Vidhubala Elangovan Palanivel Chinnakali |
| author_sort | Madhav Danthala |
| collection | DOAJ |
| description | PURPOSEThe use of all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO) in the treatment of low- and intermediate-risk acute promyelocytic leukemia (APL) is the standard of care. We report the combined use of ATRA, ATO, and daunorubicin (DNR) in patients newly diagnosed with high-risk APL. The primary focus was to describe the drug dosage modifications made in the real-world scenario.METHODSIn this descriptive study, we included 16 out of 28 patients with high-risk APL from two tertiary care centers in South India (Vijayawada and Trichy) between January 2015 and December 2018. A unique approach of initiating ATRA at a dose of 25 mg/m2 on day 1 and escalation to 45 mg/m2 after cytoreduction with DNR and hydroxyurea was followed in all patients to avert differentiation syndrome, in the setting of hyperleukocytosis at presentation.RESULTSAll patients who survived the first 3 days of admission achieved complete remission after a median duration of 29 days. There were no deaths during induction or consolidation, and the regimen was well tolerated; two patients developed grade 3/4 peripheral neuropathy requiring treatment modification. After a median follow-up duration of 1.9 years, there were no hematologic or molecular relapses.CONCLUSIONThe study sheds light on the modifications made to recommended dosages of ATRA, ATO, and DNR to optimize outcomes in high-risk APL and reaffirms the importance of ATO use in the front-line setting to achieve durable responses with minimal toxicity. |
| first_indexed | 2024-12-18T06:48:47Z |
| format | Article |
| id | doaj.art-c1ae670cb4404db49b32222f182c3ca6 |
| institution | Directory Open Access Journal |
| issn | 2687-8941 |
| language | English |
| last_indexed | 2024-12-18T06:48:47Z |
| publishDate | 2020-11-01 |
| publisher | American Society of Clinical Oncology |
| record_format | Article |
| series | JCO Global Oncology |
| spelling | doaj.art-c1ae670cb4404db49b32222f182c3ca62022-12-21T21:17:25ZengAmerican Society of Clinical OncologyJCO Global Oncology2687-89412020-11-0161749175610.1200/GO.20.00226Walking a Tightrope: Dosage Modifications and Treatment Outcomes of All-Trans-Retinoic Acid, Arsenic Trioxide, and Daunorubicin for High-Risk Acute Promyelocytic LeukemiaMadhav Danthala0Krishna Reddy Golamari1Arun Seshachalam2Anupama Mikkilineni3Sitalata Chappidi4Mahesh Babu Mekala5Vidhubala Elangovan6Palanivel Chinnakali7Department of Medical Oncology, Manipal Comprehensive Cancer Center, Manipal Hospitals, Tadepalli, Guntur District, IndiaDepartment of Medical Oncology, Manipal Comprehensive Cancer Center, Manipal Hospitals, Tadepalli, Guntur District, IndiaDepartment of Medical Oncology, Dr GVN Cancer Institute, Trichy, IndiaDepartment of Pathology, Manipal Hospitals, Tadepalli, Guntur District, IndiaDepartment of Pathology, Manipal Hospitals, Tadepalli, Guntur District, IndiaDepartment of Medical Oncology, Manipal Comprehensive Cancer Center, Manipal Hospitals, Tadepalli, Guntur District, IndiaFenivi Research SolutionsDepartment of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IndiaPURPOSEThe use of all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO) in the treatment of low- and intermediate-risk acute promyelocytic leukemia (APL) is the standard of care. We report the combined use of ATRA, ATO, and daunorubicin (DNR) in patients newly diagnosed with high-risk APL. The primary focus was to describe the drug dosage modifications made in the real-world scenario.METHODSIn this descriptive study, we included 16 out of 28 patients with high-risk APL from two tertiary care centers in South India (Vijayawada and Trichy) between January 2015 and December 2018. A unique approach of initiating ATRA at a dose of 25 mg/m2 on day 1 and escalation to 45 mg/m2 after cytoreduction with DNR and hydroxyurea was followed in all patients to avert differentiation syndrome, in the setting of hyperleukocytosis at presentation.RESULTSAll patients who survived the first 3 days of admission achieved complete remission after a median duration of 29 days. There were no deaths during induction or consolidation, and the regimen was well tolerated; two patients developed grade 3/4 peripheral neuropathy requiring treatment modification. After a median follow-up duration of 1.9 years, there were no hematologic or molecular relapses.CONCLUSIONThe study sheds light on the modifications made to recommended dosages of ATRA, ATO, and DNR to optimize outcomes in high-risk APL and reaffirms the importance of ATO use in the front-line setting to achieve durable responses with minimal toxicity.https://ascopubs.org/doi/10.1200/GO.20.00226 |
| spellingShingle | Madhav Danthala Krishna Reddy Golamari Arun Seshachalam Anupama Mikkilineni Sitalata Chappidi Mahesh Babu Mekala Vidhubala Elangovan Palanivel Chinnakali Walking a Tightrope: Dosage Modifications and Treatment Outcomes of All-Trans-Retinoic Acid, Arsenic Trioxide, and Daunorubicin for High-Risk Acute Promyelocytic Leukemia JCO Global Oncology |
| title | Walking a Tightrope: Dosage Modifications and Treatment Outcomes of All-Trans-Retinoic Acid, Arsenic Trioxide, and Daunorubicin for High-Risk Acute Promyelocytic Leukemia |
| title_full | Walking a Tightrope: Dosage Modifications and Treatment Outcomes of All-Trans-Retinoic Acid, Arsenic Trioxide, and Daunorubicin for High-Risk Acute Promyelocytic Leukemia |
| title_fullStr | Walking a Tightrope: Dosage Modifications and Treatment Outcomes of All-Trans-Retinoic Acid, Arsenic Trioxide, and Daunorubicin for High-Risk Acute Promyelocytic Leukemia |
| title_full_unstemmed | Walking a Tightrope: Dosage Modifications and Treatment Outcomes of All-Trans-Retinoic Acid, Arsenic Trioxide, and Daunorubicin for High-Risk Acute Promyelocytic Leukemia |
| title_short | Walking a Tightrope: Dosage Modifications and Treatment Outcomes of All-Trans-Retinoic Acid, Arsenic Trioxide, and Daunorubicin for High-Risk Acute Promyelocytic Leukemia |
| title_sort | walking a tightrope dosage modifications and treatment outcomes of all trans retinoic acid arsenic trioxide and daunorubicin for high risk acute promyelocytic leukemia |
| url | https://ascopubs.org/doi/10.1200/GO.20.00226 |
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