Background: Survival of patients with acute promyelocytic leukemia (APL) has dramatically improved with the use of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). Despite this, due to the complexity of initial management and the high risk of fatal thrombotic and hemorrhagic complications at presentation, early mortality (EM) remains the major contributor for treatment failure. It is less known whether advances in treatment, improvements in supportive measures, urgent access to specialized care and broad availability of ATRA and ATO have reduced EM in the last two decades.

Methods: We used data from the National Cancer Institute's Surveillance Epidemiology and End Results program (SEER-13) to determine the rates of EM (death within the first 30 days from diagnosis) and overall survival (OS) in patients with APL. Inclusion criteria was the diagnosis of APL as first malignant neoplasm among patients of all ages between 1992 and 2015. Follow up was updated to the end of 2015. Cases were grouped and analyzed according to age, children, adolescent and young adults (< 40 years) and older adults (≥ 40 years), race/ethnicity, gender, county-level income and educational achievement, and residency in rural or urban county. Trends in EM and OS were analyzed across consecutive 4-year eras.

Results: A total of 2,224 APL cases (895 <40 and 1,329 ≥ 40 years) were included in the analysis with median follow up of 41 months (range 0-287 months). Median age of patients was 45, and 1,090 (49%) were male. Most patients were White (1,228; 55.2%), 199 (9%) Black, 785 (35.3%) other ethnicity, and 12 (0.5%) unknown. Three-year OS for APL patients diagnosed in 1992-1995 was 49.2% ± 3.5% vs. 76.4 ± 2.1% for patients diagnosed in 2012-2015 (p < 0.001), Figure 1. Early mortality improved for patients < 40 years (27.4% in 1992-1995 vs. 5.4% in 2012-2015, p < 0.001), but not at the same extent for patients ≥ 40 years (35.2% in 1992-1995 vs. 22.2% in 2012-2015, p = 0.02), Figure 2. Improvements in EM are displayed in Table 1. Importantly, improvements in EM were not seen among patients of residents of rural counties.

Conclusion: These findings confirm consistent improvements in EM and OS for APL patients in the US and point to the challenge of further extending these improvements in EM rates to older patients and for those living in rural areas.

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Disclosures

Costa:Celgene: Honoraria, Research Funding; Sanofi: Honoraria; Karyopharm: Research Funding; Janssen: Research Funding; BMS: Research Funding; Abbvie: Research Funding; Amgen: Honoraria, Research Funding.

Topics:
acute promyelocytic leukemia, tretinoin, cancer, follow-up, arsenic trioxide, thrombus, treatment failure, older adult, adolescent, child

Author notes

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Asterisk with author names denotes non-ASH members.

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© 2018 by The American Society of Hematology
2018
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