Wasil Jastaniah1,2, Abdulrahman Alsultan3, Saad Al Daama4, Walid Ballourah5, Mohamed Bayoumy6, Faisal Al-Anzi7, Omar Al Shareef8, Mohammed Burhan Abrar2, Reem Al Sudairy9, Ibrahim Al Ghemlas10,11. 1. a Department of Pediatrics, Faculty of Medicine , Umm Al-Qura University , Makkah , Saudi Arabia. 2. b Princess Noorah Oncology Center , King Saud Bin Abdulaziz University and King Abdulaziz Medical City , Jeddah , Saudi Arabia. 3. c Department of Pediatrics , College of Medicine, King Saud University , Riyadh , Saudi Arabia. 4. d King Fahad Specialist Hospital , Dammam , Saudi Arabia. 5. e King Fahad Medical City , Riyadh , Saudi Arabia. 6. f King Faisal Specialist Hospital & Research Center , Jeddah , Saudi Arabia. 7. g Prince Faisal Bin Bandar Cancer Center , Qaseem , Saudi Arabia. 8. h Prince Sultan Military Medical City , Riyadh , Saudi Arabia. 9. i Department of Pediatric Hematology/Oncology , King Abdullah specialized Children's Hospital, King Abdulaziz Medical City , Riyadh , Saudi Arabia. 10. j Faculty of Medicine Alfaisal University , Riyadh , Saudi Arabia. 11. k King Faisal Specialist Hospital & Research Center , Riyadh , Saudi Arabia.
Abstract
BACKGROUND: Acute promyelocytic leukemia (APL) is a rare form of acute myelogenous leukemia (AML). Survival rates exceed 80% in developed countries. Successful treatments rely on all-trans retinoic acid with anthracycline-based chemotherapy. Availability of modern care and public knowledge play important roles in pediatric APL survival. METHOD: A cytogenetic diagnosis of APL was confirmed in 30 (14.5%) out of 207 children consecutively diagnosed with de novo AML between January 2005 and December 2012 at nine cancer care centers in Saudi Arabia. Patients were treated based on the standard protocol used by the center following the PETHEMA or the C9710 treatment protocols. We modeled 5-year overall survival (OS), event-free survival (EFS) and cumulative incidence of relapse (CIR) vs. treatment and potential covariates of age at diagnosis, involvement of central nervous system (CNS), and white blood cell (WBC) levels. RESULTS: The median age was 10.4 years with a male:female ratio of 1.9. WBC was 10 × 109/l or greater in 57% and CNS involvement was confirmed in 13%. OS, EFS, and CIR were 74 ± 12%, 55 ± 19%, and, 36 ± 17% respectively. No significant difference was found by treatment protocol. WBC levels were significantly prognostic for all negative events, but treatment with C9710 significantly ameliorated negative WBC effects. Overall outcomes were comparable to those reported in developed countries. CONCLUSIONS: Access to modern care is likely to be a critical factor in successful and comparable outcomes of childhood APL across the globe. In the present study, utilizing a cytarabine-containing protocol improved outcome of high-risk pediatric patients with APL.
BACKGROUND:Acute promyelocytic leukemia (APL) is a rare form of acute myelogenous leukemia (AML). Survival rates exceed 80% in developed countries. Successful treatments rely on all-transretinoic acid with anthracycline-based chemotherapy. Availability of modern care and public knowledge play important roles in pediatric APL survival. METHOD: A cytogenetic diagnosis of APL was confirmed in 30 (14.5%) out of 207 children consecutively diagnosed with de novo AML between January 2005 and December 2012 at nine cancer care centers in Saudi Arabia. Patients were treated based on the standard protocol used by the center following the PETHEMA or the C9710 treatment protocols. We modeled 5-year overall survival (OS), event-free survival (EFS) and cumulative incidence of relapse (CIR) vs. treatment and potential covariates of age at diagnosis, involvement of central nervous system (CNS), and white blood cell (WBC) levels. RESULTS: The median age was 10.4 years with a male:female ratio of 1.9. WBC was 10 × 109/l or greater in 57% and CNS involvement was confirmed in 13%. OS, EFS, and CIR were 74 ± 12%, 55 ± 19%, and, 36 ± 17% respectively. No significant difference was found by treatment protocol. WBC levels were significantly prognostic for all negative events, but treatment with C9710 significantly ameliorated negative WBC effects. Overall outcomes were comparable to those reported in developed countries. CONCLUSIONS: Access to modern care is likely to be a critical factor in successful and comparable outcomes of childhood APL across the globe. In the present study, utilizing a cytarabine-containing protocol improved outcome of high-risk pediatric patients with APL.
Authors: Kyung Mi Park; Keon Hee Yoo; Seong Koo Kim; Jae Wook Lee; Nack-Gyun Chung; Hee Young Ju; Hong Hoe Koo; Chuhl Joo Lyu; Seung Min Han; Jung Woo Han; Jung Yoon Choi; Kyung Taek Hong; Hyoung Jin Kang; Hee Young Shin; Ho Joon Im; Kyung-Nam Koh; Hyery Kim; Hoon Kook; Hee Jo Baek; Bo Ram Kim; Eu Jeen Yang; Jae Young Lim; Eun Sil Park; Eun Jin Choi; Sang Kyu Park; Jae Min Lee; Ye Jee Shim; Ji Yoon Kim; Ji Kyoung Park; Seom Gim Kong; Young Bae Choi; Bin Cho; Young Tak Lim Journal: Cancer Res Treat Date: 2021-04-20 Impact factor: 4.679