Acute promyelocytic leukemia (APL) in very old patients: real-life behind protocols

Serena Rosati, Carmelo Gurnari, Massimo Breccia, Ida Carmosino, Emilia Scalzulli, Enrico Montefusco, Salvatore Perrone, Ombretta Annibali, Vincenza Martini, Giulio Trapè, Gioia Colafigli, Malgorzata Trawinska, Clara Minotti, Giuseppe Cimino, Agostino Tafuri, Giuseppe Avvisati, Maurizio Martelli, Maria Teresa Voso, Roberto Latagliata

Research output: Contribution to journalArticlepeer-review


Background: Acute promyelocytic leukemia (APL) is uncommon among subjects aged ≥ 70 years and the better therapeutic strategy represents an unmet clinical need. Materials and methods: This prompted us to explore our real-life data on a retrospective cohort of 45 older APL patients (≥ 70 years) consecutively diagnosed at eight different hematologic institutions in Latium, Italy, from July 1991 to May 2019. Results: Two patients (4.4%) died from early hemorrhagic complications before treatment could begin. Twenty-two patients (51.1%) (Group A) were enrolled or treated according to standard clinical protocols, while 21 (48.8%) (Group B) received an ATRA-based personalized approach due to poor performance status. Morphologic complete remission (CR) after induction therapy was achieved in 33 patients (76.7%) with 100% of patients in Group A and 52.3% in Group B (p < 0.001). Molecular CR was documented in 30 patients (69.7%) [20/22 (90.9%) in Group A and 10/21 (47.6%) in Group B (p = 0.002)]. Ten patients (23.2%) died during induction therapy, all in Group B. Five-year overall survival (OS) of the entire cohort was 46.1% (95% CI 28.2–64.0), with 72.6% (95% CI 42.9–100) in Group A vs. 27.2% (95% CI 7.5–46.9) in the Group B (p = 0.001). Conclusions: The present analysis highlights that almost half of the patients received sub-optimal induction treatments and registered dismal outcomes demonstrating the importance of adopting standard therapies instead of modified or reduced personalized approaches also in the setting of frail older patients.

Original languageEnglish
JournalActa Oncologica
Publication statusAccepted/In press - 2021


  • Acute promyelocytic leukemia
  • all-trans retinoic acid
  • arsenic trioxide
  • elderly patients
  • real-life data

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging


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