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Early onset of chemotherapy can reduce the incidence of ATRA syndrome in newly diagnosed acute promyelocytic leukemia (APL) with low white blood cell counts: results from APL 93 trial

Leukemia volume 17, pages 339–342 (2003)Cite this article

Abstract

Treatment combining ATRA and chemotherapy (CT) has improved the outcome of APL patients, by comparison with CT alone. ATRA syndrome is a life-threatening complication of ATRA treatment whose prophylaxis remains somewhat controversial. In APL93 trial, newly diagnosed APL patients ⩽65 years and with initial WBC counts below 5000/mm3 were randomized between ATRA until CR achievement followed by CT (ATRA → CT) and ATRA with early addition of CT, on day 3 of ATRA treatment (ATRA + CT). The incidence of ATRA syndrome in the ATRA → CT arm was 18% (22/122) as compared to 9.2% (17/184) in the ATRA + CT arm (P = 0.035). In the ATRA → CT arm, three (2.5%) patients died from ATRA syndrome, as compared to one (0.5%) in the ATRA + CT group. Early addition of chemotherapy to ATRA in newly diagnosed APL with low WBC counts significantly reduced the incidence of ATRA syndrome.

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Acknowledgements

Supported by the Programme Hospitalier de Recherche Clinique (CHU Lille), the Association de Recherche contre le Cancer and the Ligue nationale contre le Cancer (Comité du Nord).

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Authors and Affiliations

  1. Service d’Hématologie Clinique, Hôpital Avicenne, 125 route de Stalingrad, Bobigny, 93009, France

    P Fenaux

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  1. S de Botton
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  2. S Chevret
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  3. V Coiteux
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  4. H Dombret
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  5. M Sanz
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  6. J San Miguel
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  8. A Vekhoff
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  9. M Gardembas
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for the European APL group

Appendix

Appendix

Dr P. Fenaux and Dr L. Degos served as cochairmen, and Dr C Chastang and S Chevret-Chastang (Department of Biostatistics, Hopital St Louis, Paris) as biostatisticians. The following clinical departments participated in APL93 trial.

French APL group

S Castaigne, H Dombret (Paris), R Zittoun (Paris), E Archimbaud (Lyon), P Travade (Clermont Ferrand), C Gardin (Clichy), A Guerci (Nancy), P Fenaux (Lille), AM Stoppa (Marseille), F Dreyfus (Paris), F Stamatoulas (Rouen), F Rigal-Huguet (Toulouse), H Guy (Dijon), JJ Sotto (Grenoble), F Maloisel (Strasbourg), J Reiffers (Pessac), A Gardembas (Angers), D Bordessoule (Limoges), N Fegueux (Montpellier), A Veil (Paris), T Lamy (Rennes), M Hayat (Villejuif), E Deconinck (Besancon), E Guyotat (St Etienne), M Martin (Annecy), E Cony-Makhoul (Bordeaux), JP Abgrall (Brest), O Reman (Caen), B Desablens (Amiens), JL Harousseau (Nantes), Y Bastion (Lyon), JP Pollet (Valenciennes), J Pulik (Argenteuil), M Lepeu (Avignon), M Renoux (Bayonne), P Morel (Lens), P Henon (Mulhouse), N Gratecos (Nice), P Colombat (Tours), D Machover (Villejuif), A Dor (Antibes), P Casassus (Bobigny), J Donadio (Castelnou), B Salles (Chalon), B Legros (Clermont Ferrand), P Audhuy (Colmar), A Dutel (Compiègne), N Philippe (Lyon), B Benothman (Meaux), C Christian (Metz), C Margueritte (Montpellier), F Witz (Nancy), A Pesce (Nice), A Baruchel (Paris), L Sutton (Paris), C Quetin (Pointe à Pitre), B Pignon (Reims), E Vilmer (Paris), E Bourquard (St Brieuc), JP Marolleau (Paris), P Robert (Toulouse), B Despax (Toulouse), G Nedellec, P Auzanneau (Paris), M Janvier (St Cloud).

Spanish AML group

O Rayon (Oviedo), M Sanz (Valencia), J San Miguel (Salamanca), J Montagud (Valencia), E Condé (Santander), P Javier de la Serna (Madrid), G Martin (Valencia), M Perez Encinas (Santiago), JP Torres Carrete (Juan Canalejo), J Zuazu (Barcelone), J Odriozola (Madrid), E Gomez-Sanz (Madrid), L Palomera (Zaragoza), L Villegas (Almeria), A Deben (Juan Canalejo), P Besalduch (Palma de Mallorca).

Cooperative AML study group, Germany

H Link (Hannover), A Ganser (Frankfurt), E Wandt (Nurnberg), A Breitenbach (Stuttgart), B Brennscheidt (Freiburg), D Herrmann (Ulm), H Soucek (Dresden), H Strobel (Erlangen).

SAKK Swiss AML group

K Geiser (Berne), M Fey (Berne), T Egger (Berne), E Jacky.

Belgian groups

JL Michaux (Bruxelles), A Bosly (Yvoir), E Meeus (Anvers), A Boulet (Mons).

Dutch groups

P Daenen (Groningen), P Muus (Nijmegen).

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de Botton, S., Chevret, S., Coiteux, V. et al. Early onset of chemotherapy can reduce the incidence of ATRA syndrome in newly diagnosed acute promyelocytic leukemia (APL) with low white blood cell counts: results from APL 93 trial. Leukemia 17, 339–342 (2003). https://doi.org/10.1038/sj.leu.2402807

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