Frontiers in Oncology (Nov 2021)
Early Death and Survival of Patients With Acute Promyelocytic Leukemia in ATRA Plus Arsenic Era: A Population-Based Study
- Hong-Hu Zhu,
- Hong-Hu Zhu,
- Hong-Hu Zhu,
- Hong-Hu Zhu,
- Ya-Fang Ma,
- Kang Yu,
- Gui-Fang Ouyang,
- Wen-Da Luo,
- Ren-Zhi Pei,
- Wei-Qun Xu,
- Hui-Xian Hu,
- Shu-Ping Mo,
- Xiao-Hua Xu,
- Jian-Ping Lan,
- Jian-Ping Shen,
- Li-Hong Shou,
- Shen-Xian Qian,
- Wei-Ying Feng,
- Pu Zhao,
- Jin-Hong Jiang,
- Bei-Li Hu,
- Jin Zhang,
- Su-Ying Qian,
- Gong-Qiang Wu,
- Wen-Ping Wu,
- Lei Qiu,
- Lin-Jie Li,
- Xiang-Hua Lang,
- Sai Chen,
- Li-Li Chen,
- Jun-Bin Guo,
- Li-Hong Cao,
- Hui-Fang Jiang,
- Yong-Ming Xia,
- Jing Le,
- Jian-Zhi Zhao,
- Jian Huang,
- Yue-Feng Zhang,
- Ya-Li Lv,
- Jing-Sheng Hua,
- Yong-Wei Hong,
- Cui-Ping Zheng,
- Ju-Xiang Wang,
- Bin-Fei Hu,
- Xiao-Hui Chen,
- Li-Ming Zhang,
- Shi Tao,
- Bing-Shou Xie,
- Yue-Min Kuang,
- Wen-Ji Luo,
- Ping Su,
- Jun Guo,
- Xiao Wu,
- Wei Jiang,
- Hui-Qi Zhang,
- Yun Zhang,
- Chun-Mei Chen,
- Xiao-Feng Xu,
- Yan Guo,
- Jin-Ming Tu,
- Shao Hu,
- Xiao-Yan Yan,
- Chen Yao,
- Yin-Jun Lou,
- Jie Jin,
- Jie Jin,
- Jie Jin,
- Jie Jin,
- the APL Cooperative Group of Zhejiang Province
Affiliations
- Hong-Hu Zhu
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Hong-Hu Zhu
- Key Laboratory of Hematologic Malignancies, Diagnosis and Treatment, Hangzhou, China
- Hong-Hu Zhu
- Zhejiang University Cancer Center, Hangzhou, China
- Hong-Hu Zhu
- Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou, China
- Ya-Fang Ma
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Kang Yu
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Hangzhou, China
- Gui-Fang Ouyang
- Department of Hematology, Ningbo First Hospital, Ningbo, China
- Wen-Da Luo
- Department of Hematology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, China
- Ren-Zhi Pei
- Department of Hematology, The Affiliated People’s Hospital of Ningbo University, Ningbo, China
- Wei-Qun Xu
- Department of Hematology, The Children’s Hospital Zhejiang University School of Medicine, Hangzhou, China
- Hui-Xian Hu
- 0Department of Hematology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
- Shu-Ping Mo
- 1Department of Hematology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
- Xiao-Hua Xu
- 2Department of Hematology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
- Jian-Ping Lan
- 3Department of Hematology, Zhejiang Provincial People’s Hospital, Hangzhou, China
- Jian-Ping Shen
- 4Department of Hematology, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, China
- Li-Hong Shou
- 5Department of Hematology, Huzhou Central Hospital, Huzhou, China
- Shen-Xian Qian
- 6Department of Hematology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Wei-Ying Feng
- 7Department of Hematology, Shaoxing People’s Hospital, Wenzhou, China
- Pu Zhao
- 8Department of Hematology, Ruian People’s Hospital, Wenzhou, China
- Jin-Hong Jiang
- 9Department of Hematology, Lishui City People’s Hospital, Lishui, China
- Bei-Li Hu
- 0Department of Hematology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
- Jin Zhang
- 1Department of Hematology, Sir Run Run Shaw Hospital (SRRSH) Affiliated with the Zhejiang University School of Medicine, Hangzhou, China
- Su-Ying Qian
- 2Department of Hematology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
- Gong-Qiang Wu
- 3Department of Hematology, Dongyang Hospital Affiliated to Wenzhou Medical University, Jinhua, China
- Wen-Ping Wu
- 4Department of Hematology, People’s Hospital of Quzhou, Quzhou, China
- Lei Qiu
- 5Department of Hematology, Zhoushan Hospital, Zhoushan, China
- Lin-Jie Li
- 6Department of Hematology, Lishui Municipal Central Hospital, Jinhua, China
- Xiang-Hua Lang
- 7Department of Hematology, The First People’s Hospital of Yongkang, Jinhua, China
- Sai Chen
- 8Department of Hematology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
- Li-Li Chen
- 9Department of Hematology and Oncology, Taizhou First People’s Hospital (Huangyan Hospital of Wenzhou Medical University), Taizhou, China
- Jun-Bin Guo
- 0Department of Hematology and Oncology, The First People’s Hospital of Wenling, Taizhou, China
- Li-Hong Cao
- 1Department of Hematology, Shulan Hospital, Hangzhou, China
- Hui-Fang Jiang
- 2Department of Hematology, Tongde Hospital of Zhejiang Province, Hangzhou, China
- Yong-Ming Xia
- 3Department of Hematology, Rheumatology and Nephrology, Yuyao People’s Hospital, Ningbo University Yangming Affiliated Hospital, Ningbo, China
- Jing Le
- 4Department of Hematology and Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo, China
- Jian-Zhi Zhao
- 5Department of Hematology, Shaoxing Central Hospital, Shaoxing, China
- Jian Huang
- 6Department of Hematology, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Jinhua, China
- Yue-Feng Zhang
- 7Department of Hematology, The First People’s Hospital of Yuhang District, Hangzhou, China
- Ya-Li Lv
- 8Department of Hematology, Xinchang People’s Hospital, Shaoxing, China
- Jing-Sheng Hua
- 9Department of Hematology and Oncology, Taizhou Municipal Hospital, Taizhou, China
- Yong-Wei Hong
- 0Department of Hematology, Ningbo Yinzhou No. 2 Hospital, Ningbo, China
- Cui-Ping Zheng
- 1Department of Hematotherapeutic, Wenzhou Central Hospital Medical Group, Wenzhou, China
- Ju-Xiang Wang
- 2Department of Hematology and Oncology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- Bin-Fei Hu
- 3Department of Pediatric Hematology, Ningbo Women and Children’s Hospital, Ningbo, China
- Xiao-Hui Chen
- 4Department of Hematology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
- Li-Ming Zhang
- 5Department of Hematology, Zhuji People’s Hospital, Shaoxing, China
- Shi Tao
- 6Department of Hematology, Shaoxing Second Hospital, Shaoxing, China
- Bing-Shou Xie
- 7Department of Hematology, Wenzhou People’s Hospital, Wenzhou, China
- Yue-Min Kuang
- 8Department of Hematology, Jinhua People’s Hospital, Jinhua, China
- Wen-Ji Luo
- 9Department of Hematology, The First People’s Hospital of Xiaoshan District, Hangzhou, China
- Ping Su
- 0Department of Hematology, Zhejiang Xiaoshan Hospital, Hangzhou, China
- Jun Guo
- 1Department of Hematology and Oncology, The Sencond Affiliated Hospital of Zhejiang University, SAHZU Changxing Branch, Huzhou, China
- Xiao Wu
- 2Department of Oncology and Hematology, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
- Wei Jiang
- 3Department of Hematology, Shangyu People’s Hospital, Shaoxing, China
- Hui-Qi Zhang
- 4Department of Hematology, The First People’s Hospital of Huzhou, Huzhou, China
- Yun Zhang
- 5Department of Hematotherapeutic, Yueqing People’s Hospital, Wenzhou, China
- Chun-Mei Chen
- 6Department of Hematotherapeutic, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- Xiao-Feng Xu
- 7Department of Oncology and Hematology, Hangzhou Red Cross Hospital, Hangzhou, China
- Yan Guo
- 8Department of Hematology, The First People’s Hospital of Pinghu, Jiaxing, China
- Jin-Ming Tu
- 9Department of Gastroenterology and Hematology, Longyou People’s Hospital, Quzhou, China
- Shao Hu
- 0Department of Hematology and Oncology, The First Hospital of Ninghai County, Ningbo, China
- Xiao-Yan Yan
- 1Department of Biostatistics, Peking University Clinical Research Institute, Beijing, China
- Chen Yao
- 1Department of Biostatistics, Peking University Clinical Research Institute, Beijing, China
- Yin-Jun Lou
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Jie Jin
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Jie Jin
- Key Laboratory of Hematologic Malignancies, Diagnosis and Treatment, Hangzhou, China
- Jie Jin
- Zhejiang University Cancer Center, Hangzhou, China
- Jie Jin
- Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou, China
- the APL Cooperative Group of Zhejiang Province
- DOI
- https://doi.org/10.3389/fonc.2021.762653
- Journal volume & issue
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Vol. 11
Abstract
Most randomized trials for acute promyelocytic leukemia (APL) have investigated highly selected patients under idealized conditions, and the findings need to be validated in the real world. We conducted a population-based study of all APL patients in Zhejiang Province, China, with a total population of 82 million people, to assess the generalization of all-trans retinoic acid (ATRA) and arsenic as front-line treatment. The outcomes of APL patients were also analyzed. Between January 2015 and December 2019, 1,233 eligible patients were included in the final analysis. The rate of ATRA and arsenic as front-line treatment increased steadily from 66.2% in 2015 to 83.3% in 2019, with no difference among the size of the center (≥5 or <5 patients per year, p = 0.12) or age (≥60 or <60 years, p = 0.35). The early death (ED) rate, defined as death within 30 days after diagnosis, was 8.2%, and the 3-year overall survival (OS) was 87.9% in the whole patient population. Age (≥60 years) and white blood cell count (>10 × 109/L) were independent risk factors for ED and OS in the multivariate analysis. This population-based study showed that ATRA and arsenic as front-line treatment are widely used under real-world conditions and yield a low ED rate and a high survival rate, which mimic the results from clinical trials, thereby supporting the wider application of APL guidelines in the future.
Keywords
