Improving acute promyelocytic leukemia (APL) outcome in developing countries through networking, results of the International Consortium on APL.

Eduardo M. Rego, Haesook T. Kim, Guillermo J. Ruiz-Argüelles, Maria Soledad Undurraga, Maria del Rosario Uriarte, Rafael H. Jacomo, Homero Gutiérrez-Aguirre, Raul A M Melo, Rosane Bittencourt, Ricardo Pasquini, Katia Pagnano, Evandro M. Fagundes, Maria de Lourdes Chauffaille, Carlos S. Chiattone, Lem Martinez, Luis A. Meillón, David Gómez-Almaguer, Hau C. Kwaan, Javier Garcés-Eisele, Robert Gallagher & 10 others Charlotte M. Niemeyer, Stanley L. Schrier, Martin Tallman, David Grimwade, Arnold Ganser, Nancy Berliner, Raul C. Ribeiro, Francesco Lo-Coco, Bob Löwenberg, Miguel A. Sanz

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Thanks to modern treatment with all-trans retinoic acid and chemotherapy, acute promyelocytic leukemia (APL) is now the most curable type of leukemia. However, this progress has not yielded equivalent benefit in developing countries. The International Consortium on Acute Promyelocytic Leukemia (IC-APL) was established to create a network of institutions in developing countries that would exchange experience and data and receive support from well-established US and European cooperative groups. The IC-APL formulated expeditious diagnostic, treatment, and supportive guidelines that were adapted to local circumstances. APL was chosen as a model disease because of the potential impact on improved diagnosis and treatment. The project included 4 national coordinators and reference laboratories, common clinical record forms, 5 subcommittees, and laboratory and data management training programs. In addition, participating institutions held regular virtual and face-to-face meetings. Complete hematological remission was achieved in 153/180 (85%) patients and 27 (15%) died during induction. After a median follow-up of 28 months, the 2-year cumulative incidence of relapse, overall survival (OS), and disease-free survival (DFS) were 4.5%, 80%, and 91%, respectively. The establishment of the IC-APL network resulted in a decrease of almost 50% in early mortality and an improvement in OS of almost 30% compared with historical controls, resulting in OS and DFS similar to those reported in developed countries.

Original languageEnglish
Pages (from-to)1935-1943
Number of pages9
JournalBlood
Volume121
Issue number11
DOIs
Publication statusPublished - Mar 14 2013

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Acute Promyelocytic Leukemia
Developing countries
Developing Countries
Chemotherapy
Disease-Free Survival
Survival
Tretinoin
Information management
Developed Countries
Leukemia
Therapeutics
Guidelines
Education
Recurrence
Drug Therapy
Mortality
Incidence

ASJC Scopus subject areas

  • Hematology
  • Biochemistry
  • Cell Biology
  • Immunology

Cite this

Rego, E. M., Kim, H. T., Ruiz-Argüelles, G. J., Undurraga, M. S., Uriarte, M. D. R., Jacomo, R. H., ... Sanz, M. A. (2013). Improving acute promyelocytic leukemia (APL) outcome in developing countries through networking, results of the International Consortium on APL. Blood, 121(11), 1935-1943. https://doi.org/10.1182/blood-2012-08-449918

Improving acute promyelocytic leukemia (APL) outcome in developing countries through networking, results of the International Consortium on APL. / Rego, Eduardo M.; Kim, Haesook T.; Ruiz-Argüelles, Guillermo J.; Undurraga, Maria Soledad; Uriarte, Maria del Rosario; Jacomo, Rafael H.; Gutiérrez-Aguirre, Homero; Melo, Raul A M; Bittencourt, Rosane; Pasquini, Ricardo; Pagnano, Katia; Fagundes, Evandro M.; Chauffaille, Maria de Lourdes; Chiattone, Carlos S.; Martinez, Lem; Meillón, Luis A.; Gómez-Almaguer, David; Kwaan, Hau C.; Garcés-Eisele, Javier; Gallagher, Robert; Niemeyer, Charlotte M.; Schrier, Stanley L.; Tallman, Martin; Grimwade, David; Ganser, Arnold; Berliner, Nancy; Ribeiro, Raul C.; Lo-Coco, Francesco; Löwenberg, Bob; Sanz, Miguel A.

In: Blood, Vol. 121, No. 11, 14.03.2013, p. 1935-1943.

Research output: Contribution to journalArticle

Rego, EM, Kim, HT, Ruiz-Argüelles, GJ, Undurraga, MS, Uriarte, MDR, Jacomo, RH, Gutiérrez-Aguirre, H, Melo, RAM, Bittencourt, R, Pasquini, R, Pagnano, K, Fagundes, EM, Chauffaille, MDL, Chiattone, CS, Martinez, L, Meillón, LA, Gómez-Almaguer, D, Kwaan, HC, Garcés-Eisele, J, Gallagher, R, Niemeyer, CM, Schrier, SL, Tallman, M, Grimwade, D, Ganser, A, Berliner, N, Ribeiro, RC, Lo-Coco, F, Löwenberg, B & Sanz, MA 2013, 'Improving acute promyelocytic leukemia (APL) outcome in developing countries through networking, results of the International Consortium on APL.', Blood, vol. 121, no. 11, pp. 1935-1943. https://doi.org/10.1182/blood-2012-08-449918
Rego, Eduardo M. ; Kim, Haesook T. ; Ruiz-Argüelles, Guillermo J. ; Undurraga, Maria Soledad ; Uriarte, Maria del Rosario ; Jacomo, Rafael H. ; Gutiérrez-Aguirre, Homero ; Melo, Raul A M ; Bittencourt, Rosane ; Pasquini, Ricardo ; Pagnano, Katia ; Fagundes, Evandro M. ; Chauffaille, Maria de Lourdes ; Chiattone, Carlos S. ; Martinez, Lem ; Meillón, Luis A. ; Gómez-Almaguer, David ; Kwaan, Hau C. ; Garcés-Eisele, Javier ; Gallagher, Robert ; Niemeyer, Charlotte M. ; Schrier, Stanley L. ; Tallman, Martin ; Grimwade, David ; Ganser, Arnold ; Berliner, Nancy ; Ribeiro, Raul C. ; Lo-Coco, Francesco ; Löwenberg, Bob ; Sanz, Miguel A. / Improving acute promyelocytic leukemia (APL) outcome in developing countries through networking, results of the International Consortium on APL. In: Blood. 2013 ; Vol. 121, No. 11. pp. 1935-1943.
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abstract = "Thanks to modern treatment with all-trans retinoic acid and chemotherapy, acute promyelocytic leukemia (APL) is now the most curable type of leukemia. However, this progress has not yielded equivalent benefit in developing countries. The International Consortium on Acute Promyelocytic Leukemia (IC-APL) was established to create a network of institutions in developing countries that would exchange experience and data and receive support from well-established US and European cooperative groups. The IC-APL formulated expeditious diagnostic, treatment, and supportive guidelines that were adapted to local circumstances. APL was chosen as a model disease because of the potential impact on improved diagnosis and treatment. The project included 4 national coordinators and reference laboratories, common clinical record forms, 5 subcommittees, and laboratory and data management training programs. In addition, participating institutions held regular virtual and face-to-face meetings. Complete hematological remission was achieved in 153/180 (85{\%}) patients and 27 (15{\%}) died during induction. After a median follow-up of 28 months, the 2-year cumulative incidence of relapse, overall survival (OS), and disease-free survival (DFS) were 4.5{\%}, 80{\%}, and 91{\%}, respectively. The establishment of the IC-APL network resulted in a decrease of almost 50{\%} in early mortality and an improvement in OS of almost 30{\%} compared with historical controls, resulting in OS and DFS similar to those reported in developed countries.",
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