Acute Promyelocytic Leukemia: A Long-Term Retrospective Study in Mexico

Nidia Zapata-Canto, Manuel Aguilar, Luara Arana, Efren Montano, Cristian Ramos-Penafiel, Jose Antonio De la Pena, Jose Luis Alvarez-Vera, Eugenia Espitia-Rios, Juan Manuel Perez Zuniga, Eleazar Hernandez-Ruiz, Eduardo Cervera, Ramiro Espinoza-Zamora, Alejandro Sosa-Espinoza, Juan Carlos Solis-Poblano, Roberta Demichelis, David Gomez-Almaguer, Esperanza Barrera, Javier Mijangos, Ruben Solis-Armenta, Oscar de Jesus Perez, Miguel Herrera, Guillermo Diaz-Vargas, Alvaro Cabrera-Garcia, Juan Antonio Flores-Jimenez, Javier Morales-Adrian, Eva Fabiola Ramirez-Romero, Adrian Ceballos-Lopez, Victor Antonio Guillermo, Manuel Solano Manuel, Esthela Juan Lien-Chang Lourdes, Juan Ojeda-Tovar, Gladys Gomez-Perdomo, Martha Alvarado-Ibarra


Background: The present retrospective study reviewed acute promyelocytic leukemia (APL) cases recorded in Mexico between January 2007 and January 2017. The primary objective of the study was to evaluate overall survival (OS) in Mexican patients with APL. Secondary objective was to evaluate the impact of induction treatment with different anthracyclines on OS, event-free survival (EFS) and complications in this patient population.

Methods: The medical charts of patients referred to medical institutions in Mexico from January 2007 through January 2017 for the treatment of suspected APL were reviewed retrospectively. Patients aged 15 - 75 years, in whom the diagnosis of APL was confirmed, who had an Eastern Cooperative Group performance status of 0 - 2, and who were eligible for combined treatment with intensive chemotherapy and all-trans retinoic acid (ATRA), were included in the study. Study participants received induction and consolidation treatment with ATRA plus either daunorubicin or idarubicin, followed by 2 years of single-agent ATRA as maintenance therapy. Patients who were unable to pay for ATRA treatment received anthracycline-based induction and consolidation, with methotrexate plus mercaptopurine as maintenance therapy.

Results: A total of 360 patients from 21 public and private hospitals were included in the study. The median age of the population was 37 years, and 51% were male. Of the 360 patients, 205 (57%) vs. 155 (43%) received daunorubicin vs. idarubicin as induction treatment for APL. ATRA was administered to 201 (98%) patients in the daunorubicin group vs. 138 (89%) in the idarubicin group (P = 0.001), and was initiated at diagnosis in 92% vs. 73% of recipients, respectively (P = 0.0001). At 150 months, OS and EFS for the entire population were 84% and 79%, respectively. Both OS (90% vs. 76%, P = 0.003) and EFS (85% vs. 72%, P = 0.001) were significantly prolonged in daunorubicin vs. idarubicin recipients. Rates of complications were similar in the two groups.

Conclusions: As arsenic trioxide (ATO) is not currently available in Mexico, anthracycline plus ATRA is the mainstay of treatment for APL here. Our results confirm the efficacy of this strategy, with high OS and EFS rates being observed 12.5 years after diagnosis.

J Hematol. 2021;10(2):53-63


Acute promyelocytic leukemia; Mexico; Retrospective study; ATRA; Daunorubicin; Idarubicin; Anthracycline

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