A survival study and prognostic factors analysis on acute promyelocytic leukemia at a single center.

ABSTRACT

This study was aimed to investigate the factors influencing long-term survival on patients with acute promyelocytic leukemia. Here, we present a single center retrospective study with long-term follow-up to explore the prognostic factors and a rationale of the using of ATRA, chemotherapy and As(2)O(3) in the treatment of newly diagnosed APL patients. In total, 222 patients, 184 achieved complete remission (CR) with the CR rate of 82.88% and 22 patients died during early induction therapy with the early-death-rate of 10%. Total 171 newly diagnosed APL patients entering CR were retrospectively analyzed from November 1989 to December 2004,with a median follow-up of 36 months (6-185 months). Univariate and multivariate analysis of eight factors potentially influencing survival and prognosis were carried out with Log-Rank and Cox regression method, including sex, age, initial WBC count, the level of lactic dehydrogenase (LDH), first induction regimen, days from induction therapy to CR, post-remission therapy and the status of PML-RAR alpha fusion gene by reverse transcription-polymerase chain reaction (RT-PCR). The results showed that the estimated 5-year overall survival (OS) and relapse-free survival (RFS) were 80.9+/-4.0 and 71.0+/-4.0%, respectively. Univariate analyses showed that initial WBC count, first induction regimen, days from induction therapy to CR, post-remission therapy regimen and the status of PML-RAR alpha in remission were important prognostic factors for long-term survival. Multivariate study showed that only post-remission therapy regimen was associated with RFS and OS. It is concluded that the post-remission treatment combining ATRA, As(2)O(3) and chemotherapy would significantly improve the long-term survival of APL patients achieving CR(1).