Long Term Results of Patients with Acute Promyelocytic Leukemia of Recent Diagnosis Treated with Daunorubicin or Epirubicin in Induction Therapy

INTRODUCTION Acute Promyelocytic Leukemia (APL), is an hematological emergency due to a high early mortality rate because of hemorrhages. When diagnosed, specific and simultaneous actions are required, including the start of tretinoin and the necessary steps to treat coagulopathy.

OBJECTIVE To learn the event free survival and the overall survival of patients with APL that are treated in a Mexican Medical Center with two different anthracyclines.

MATERIAL AND METHODS Prospective, longitudinal, open comparative study. All patients diagnosed with APL by morphology were included, with t(15;17) and /or PML/RARα positive candidates to be treated with chemotherapy protocol denominated LAP-3, which consists on Induction: ATRA + Daunorubicin (availability from 2009-2012) or Epirubicin (2013-2015), 2 post remission therapies with anthracyclines, and two year continuance of Mercaptopurine, Metotrexate and ATRA during cycles of 25 days every 3 months. Patients with serious organic shortcomings, HIV positives and pregnant women were excluded.

RESULTS 30 patients were analyzed: 17 men and 13 women. The average age was 36 (16-73), the median line leukocytes was 4.5/mcl (400-370,000) of platelets 42,000 (9,000-386,000), the hematocrit 25% (6 to 42), fibrinogen of 233mg (22 to 730). 11 patients had high risk, 8 intermediate risk, and 11 low risk. 15 of them were treated with Induction with Daunorubicin and 15 with Epirubicin, only 4 patients developed ATRA syndrome; there were 7 deaths during the first 30 days, 5 from DIC (disseminated intravascular coagulation) and 2 from infection. 23 patients were evaluated for remission and all of them received it (100%). The event free survival was 87% for Daunorubicin and 60% for Epirubicin (p=0.08) with a follow up of 72 months, and the Overall Survival 87% for Daunorbicin and 67% for Epirubicin (p=0.02). In the case of patients who were not treated with ATRA, the mortality was 100% (p=0.004).

CONCLUSION Results prove that patients who were treated with Daunorubicin had a better prognosis than the ones treated with Epirubicin, and the main cause of death during the first month were the complications associated to DIC.