Journal Article Epublish
PubMed: 42794865 DOI: 10.3390/cancers18182899
A Comparison of Outcomes in Patients with Secondary Acute Promyelocytic Leukemia (APL) and De Novo APL-A Case-Matched Retrospective Analysis of the Polish Adult Leukemia Group (PALG).
Cancers (Basel) 18(18)
Authors: Agnieszka Pluta, Damian Mikulski, Marta Sobas, Kinga Strzałka, Magdalena Czemerska, Dominika Trybunia-Orzeszek, Tomasz Wrobel, Bozena Budziszewska, Marzena Wątek, Ewa Lech-Maranda, Tomasz Gromek, Dorota Hawrylecka, Marek Hus, Ewa Zarzycka, Jan Maciej Zaucha, Anna Armatys, Grzegorz Helbig, Jolanta Oleksiuk, Łukasz Bołkun, Andrzej Szczepaniak, Lidia Gil, Rafał Becht, Wojciech Fendler, Sebastian Giebel, Agnieszka Wierzbowska
Affiliations
- Department of Hematology, Medical University of Lodz, 90-419 Lodz, Poland.
- The Nicolas Copernicus Multidisciplinary Provincial Center of Traumatology and Oncology, 93-513 Lodz, Poland.
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 93-510 Lodz, Poland.
- Department of Hematology, Blood Neoplasm and Bone Marrow Transplantation, Piast Medical University, 50-367 Wroclaw, Poland.
- Department of Hematology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland.
- Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland.
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-080 Lublin, Poland.
- Department of Hematology and Transplantation, Medical University of Gdansk, 80-952 Gdansk, Poland.
- Department of Hematology and Bone Marrow Transplantation, Medical School of Silesia, 40-032 Katowice, Poland.
- Department of Hematology, Medical University Hospital, 15-276 Bialystok, Poland.
- Department of Hematology, Transplantation and Cellular Therapy, Poznan University of Medical Sciences, 60-569 Poznan, Poland.
- Clinical Department of Oncology, Chemotherapy and Cancer Immunotherapy, Pomeranian Medical University, 71-252 Szczecin, Poland.
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Institute-Cancer Center, Gliwice Branch, 44-101 Gliwice, Poland.
Abstract
BACKGROUND
Secondary acute promyelocytic leukemia (sAPL) is a very rare subtype of acute myeloid leukemia that develops following exposure to chemotherapy, radiotherapy, or immunosuppressive agents. The treatment results and survival outcomes of sAPL patients are still not precisely defined.
METHODS
A search of the Polish Adult Leukemia Group (PALG) database identified 29 cases of sAPL (median age 57 years; 62.1% female) among 437 APL patients (6.7%) diagnosed between 2006 and 2024. Each sAPL case was matched to a de novo APL patient by sex, age, year of diagnosis, and treatment protocol (LPA (Leucemia Promielocítica Aguda) 2005, LPA 2012, or LPA 2017).
RESULTS
All sAPL cases occurred following chemo- and/or radiotherapy, most commonly for breast cancer. The sAPL cases demonstrated higher CD15 expression than the de novo APL cases (median 27.6% vs. 7%, p = 0.04). The two groups exhibited comparable complete remission rates (82.8% sAPL vs. 75.9% de novo; p = 0.75) and early mortality rates (17.2% vs. 20.7%, p = 1.0). However, relapse-free survival was significantly shorter in sAPL (median 94.7 months vs. not reached; HR 7.23, 95% CI 1.63-32.02, p = 0.030), whereas overall survival did not differ significantly between groups. Multivariate analysis identified Eastern Cooperative Oncology Group performance status ≥3 and CD15 expression > 20% as independent predictors of inferior survival.
CONCLUSIONS
These findings suggest that sAPL shares many clinical features with de novo APL but carries a higher risk of relapse, highlighting the need for further prospective studies and the potential implementation of tailored therapeutic strategies.
MeSH
Radiotherapy, Leukemia, Promyelocytic, Acute, Leukemia, Therapeutics