Patient characteristics
| Patient . | Age at APL diagnosis, y . | Primary malignancy . | Treatment of primary malignancy . | Cumulative dose of epirubicin, mg/m2 . | Latency, mo* . | Cytogenetics . | PML breakpoint . | RARA breakpoint¶ . | APL therapy . | Current status of APL . | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| der(15) . | der(17) . | der(15) . | der(17) . | |||||||||
| UPN1 | 40 | Breastcarcinoma | 4 Cycles of epirubicin (165 mg), 6 cycles of CMF (cyclophosphamide 990 mg, methotrexate 65 mg, 5FU 990 mg) | 400 | 48 | t(15;17)(q22;q12-21) idem, del(5)(q?31q?35) | 1186† | 1185† | 13463 | 13437 | PETHEMA‡ | Alive in first CRm at 61 mo |
| UPN2 | 47 | Breastcarcinoma | 4 Cycles of epirubicin (175 mg) + cyclophosphamide (1180 mg) DXT | 400 | 28 | t(7;14)(q32;q22), t(15;17)(q22;q21) | 1270§ | 1267§ | 16192 | 16192 | MRC‡ | Alive in first CRm at 43 mo; treatment complicated by anthracycline-related cardiomyopathy (ejection fraction 30%–40%) |
| UPN3 | 41 | Breastcarcinoma | 6 Cycles of epirubicin (118 mg) + cyclophosphamide (940 mg) DXT | 450 | 18 | t(15;17)(q22;q21) | 379-80§ | 375-76§ | 9291-92 | 9293-94 | MRC‡ | Death in first CRm (fungal infection) at 5 mo |
| UPN4 | 55 | Breastcarcinoma | 4 Cycles of epirubicin (200 mg), 4 cycles of CMF (cyclophosphamide 1200 mg, methotrexate 80 mg, 5FU 1200 mg) DXT | 400 | 18 | der(12), t(8;12)(q13;p13), t(15;17)(q22;q21) | 1184-85† | 1187-1191† | 13332-33 | 13336-40 | PETHEMA‡ | Alive in first CRm at 42 mo |
| UPN5 | 60 | Breastcarcinoma | 6 Cycles of FEC (5FU 975 mg, epirubicin 98 mg, cyclophosphamide 980 mg), DXT | 360 | 24 | t(15;17)(q22;q21) | 1968‖ | 1964-65‖ | 16196 | 16192-93 | MRC‡ | Induction death (typhlitis) at 13 da |
| UPN6 | 55 | Breastcarcinoma | 6 Cycles of FEC (5FU 1100 mg, epirubicin 110 mg, cyclophosphamide 1100 mg × 3; 5FU 1000 mg, epirubicin 100 mg, cyclophosphamide 1000 mg × 3) DXT | 300 | 27 | t(15;17)(q22;q21) | 955-57† | 955-59† | 14882-84 | 14884-88 | PETHEMA‡ #1 ATO + ATRA consolidation | Alive in first CRm at 15 mo |
| Patient . | Age at APL diagnosis, y . | Primary malignancy . | Treatment of primary malignancy . | Cumulative dose of epirubicin, mg/m2 . | Latency, mo* . | Cytogenetics . | PML breakpoint . | RARA breakpoint¶ . | APL therapy . | Current status of APL . | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| der(15) . | der(17) . | der(15) . | der(17) . | |||||||||
| UPN1 | 40 | Breastcarcinoma | 4 Cycles of epirubicin (165 mg), 6 cycles of CMF (cyclophosphamide 990 mg, methotrexate 65 mg, 5FU 990 mg) | 400 | 48 | t(15;17)(q22;q12-21) idem, del(5)(q?31q?35) | 1186† | 1185† | 13463 | 13437 | PETHEMA‡ | Alive in first CRm at 61 mo |
| UPN2 | 47 | Breastcarcinoma | 4 Cycles of epirubicin (175 mg) + cyclophosphamide (1180 mg) DXT | 400 | 28 | t(7;14)(q32;q22), t(15;17)(q22;q21) | 1270§ | 1267§ | 16192 | 16192 | MRC‡ | Alive in first CRm at 43 mo; treatment complicated by anthracycline-related cardiomyopathy (ejection fraction 30%–40%) |
| UPN3 | 41 | Breastcarcinoma | 6 Cycles of epirubicin (118 mg) + cyclophosphamide (940 mg) DXT | 450 | 18 | t(15;17)(q22;q21) | 379-80§ | 375-76§ | 9291-92 | 9293-94 | MRC‡ | Death in first CRm (fungal infection) at 5 mo |
| UPN4 | 55 | Breastcarcinoma | 4 Cycles of epirubicin (200 mg), 4 cycles of CMF (cyclophosphamide 1200 mg, methotrexate 80 mg, 5FU 1200 mg) DXT | 400 | 18 | der(12), t(8;12)(q13;p13), t(15;17)(q22;q21) | 1184-85† | 1187-1191† | 13332-33 | 13336-40 | PETHEMA‡ | Alive in first CRm at 42 mo |
| UPN5 | 60 | Breastcarcinoma | 6 Cycles of FEC (5FU 975 mg, epirubicin 98 mg, cyclophosphamide 980 mg), DXT | 360 | 24 | t(15;17)(q22;q21) | 1968‖ | 1964-65‖ | 16196 | 16192-93 | MRC‡ | Induction death (typhlitis) at 13 da |
| UPN6 | 55 | Breastcarcinoma | 6 Cycles of FEC (5FU 1100 mg, epirubicin 110 mg, cyclophosphamide 1100 mg × 3; 5FU 1000 mg, epirubicin 100 mg, cyclophosphamide 1000 mg × 3) DXT | 300 | 27 | t(15;17)(q22;q21) | 955-57† | 955-59† | 14882-84 | 14884-88 | PETHEMA‡ #1 ATO + ATRA consolidation | Alive in first CRm at 15 mo |
APL indicates acute promyelocytic leukemia; CRm, molecular remission; DXT, radiotherapy; 5FU, fluorouracil; UPN: Unique patient number; and #1, course 1.
Length of time between first epirubicin exposure and presentation with therapy-related APL.
Patients were treated with an extended course of all-trans retinoic acid (ATRA) given simultaneously with induction chemotherapy. Medical Research Council (MRC) and PETHEMA treatment schedules were given as described.16 UPN6 received consolidation with arsenic trioxide (ATO) and ATRA according to the National Cancer Research Institute AML17 protocol (http://aml17.cardiff.ac.uk).