Cancers (Jun 2020)

Impact of CD56 Continuously Recognizable as Prognostic Value of Acute Promyelocytic Leukemia: Results of Multivariate Analyses in the Japan Adult Leukemia Study Group (JALSG)-APL204 Study and a Review of the Literature

  • Akihiro Takeshita,
  • Norio Asou,
  • Yoshiko Atsuta,
  • Hiroaki Furumaki,
  • Toru Sakura,
  • Yasunori Ueda,
  • Masashi Sawa,
  • Nobuaki Dobashi,
  • Yasuhiro Taniguchi,
  • Rikio Suzuki,
  • Masaru Nakagawa,
  • Shigehisa Tamaki,
  • Maki Hagihara,
  • Katsumichi Fujimaki,
  • Hitoshi Minamiguchi,
  • Hiroyuki Fujita,
  • Masamitsu Yanada,
  • Yoshinobu Maeda,
  • Noriko Usui,
  • Yukio Kobayashi,
  • Hitoshi Kiyoi,
  • Shigeki Ohtake,
  • Itaru Matsumura,
  • Tomoki Naoe,
  • Yasushi Miyazaki,
  • the Japan Adult Leukemia Study Group

DOI
https://doi.org/10.3390/cancers12061444
Journal volume & issue
Vol. 12, no. 6
p. 1444

Abstract

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Background: After long-term analysis of the JALSG-APL204 study we recently reported that maintenance therapy with tamibarotene was more effective than all-trans retinoic acid (ATRA) by reducing relapse in APL patients. Here, the clinical significance of other important prognostic factors was evaluated with multivariate analyses. Patients and Methods: Newly diagnosed acute promyelocytic leukemia (APL) patients were registered with the study. Induction was composed of ATRA and chemotherapy. Patients who achieved molecular remission after consolidation were randomly assigned to maintenance with tamibarotene or ATRA. Results: Of the 344 eligible patients, 319 (93%) achieved complete remission (CR). After completing consolidation, 269 patients underwent maintenance random assignment—135 to ATRA, and 134 to tamibarotene. By multivariate analysis, overexpression of CD56 in blast was an independent unfavorable prognostic factor for relapse-free survival (RFS) (p = 0.006) together with more than 10.0 × 109/L WBC counts (p = 0.001) and the ATRA arm in maintenance (p = 0.028). Of all phenotypes, CD56 was related most clearly to an unfavorable prognosis. The CR rate, mortality rate during induction and overall survival of CD56+ APL were not significantly different compared with CD56− APL. CD56 is continuously an independent unfavorable prognostic factor for RFS in APL patients treated with ATRA and chemotherapy followed by ATRA or tamibarotene maintenance therapy.

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