Acute Promyelocytic Leukemia Clinical Trial
Official title:
Long-Term Quality of Life in Patients With Acute Promyelocytic Leukemia: a Follow-up Observational Study of Patients Enrolled in the GIMEMA AIDA 0493 and AIDA 200
This study will focus on acute promyelocytic leukemia patients who have been diagnosed more
than 5 years ago and their present quality of life.
The possible late effects of cancer treatment can include several issues and, thus, there
has been an increasing interest worldwide in studying the long-term impact of these in
patients' life.
This study will focus on long-term survivors as defined by the America Cancer Society, that
is surviving the initial diagnosis for more than 5 years. Previous research has investigated
long-term Health Related Quality of Life (HRQOL) in patients with acute myeloid leukemia,
however, this will be the first research conducted to investigate long-term HRQOL outcomes
in patients with acute promyelocytic leukemia (APL).
The potential late effects of cancer treatment can include second malignancies or other
chronic conditions affecting physical and emotional well-being. Therefore, there has been an
increasing interest worldwide in evaluating the longer-term impact of cancer and its
treatment. Currently large cohort of patients enjoys disease-free survival of 5 years or
longer. However, a disease-free status is not synonymous with a life free of physical and
psychological health related to the cancer and/or its treatment. Research shows that cancer
related health concerns persist long after initial treatment and this has been shown in
several cancer populations including prostate, testicular, breast cancer and lymphoma
patients. Long-term cancer survivors can experience treatment-induced morbidity (e.g.
cardiovascular damage due to chemotherapy or radiotherapy; infertility and second tumors),
chronic disease and treatment-related symptoms, functional impairment, psychosocial
problems, and practical problems.
Since the introduction of the vitamin A derivative all-trans retinoic acid (ATRA) as
front-line therapy for APL, the outcome of this acute leukemia subtype has changed from the
state of a most frequently fatal leukemia to the condition of a highly curable disease. The
Italian cooperative group GIMEMA designed in 1993 the AIDA (Atra plus IDArubicin) trial for
newly diagnosed APL. Results on over 800 patients showed a complete remission (CR) rate >
90% and an overall survival of 76% and confirmed that the concomitant administration of ATRA
and chemotherapy is more effective than the sequential administration. Following the
identification of distinct prognostic categories among APL patients, the GIMEMA group
designed a new trial (AIDA2000) in which the intensity of post-remission treatment was
adapted to the relapse risk and 498 patients were enrolled since January 2000. The results
recently published showed a CR rate >90% with molecular remission rate after third
consolidation of 98%. The new schedule allowed a Disease Free Survival (DFS) of 86% and
showed that a risk-adapted strategy including ATRA for consolidation provides an outcome
improvement in newly diagnosed patients. As reported by an international panel of experts,
simultaneous ATRA and anthracycline chemotherapy schedules such as those used in the AIDA
protocols represent the state of the art therapy for newly diagnosed APL.
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Observational Model: Case Control, Time Perspective: Cross-Sectional
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