Improving acute promyelocytic leukemia (APL) outcome in developing countries through networking, results of the International Consortium on APL.


Thanks to modern treatment with all-trans retinoic acid and chemotherapy, acute promyelocytic leukemia (APL) is now the most curable type of leukemia. However, this progress has not yielded equivalent benefit in developing countries. The International Consortium on Acute Promyelocytic Leukemia (IC-APL) was established to create a network of institutions in developing countries that would exchange experience and data and receive support from well-established US and European cooperative groups. The IC-APL formulated expeditious diagnostic, treatment, and supportive guidelines that were adapted to local circumstances. APL was chosen as a model disease because of the potential impact on improved diagnosis and treatment. The project included 4 national coordinators and reference laboratories, common clinical record forms, 5 subcommittees, and laboratory and data management training programs. In addition, participating institutions held regular virtual and face-to-face meetings. Complete hematological remission was achieved in 153/180 (85%) patients and 27 (15%) died during induction. After a median follow-up of 28 months, the 2-year cumulative incidence of relapse, overall survival (OS), and disease-free survival (DFS) were 4.5%, 80%, and 91%, respectively. The establishment of the IC-APL network resulted in a decrease of almost 50% in early mortality and an improvement in OS of almost 30% compared with historical controls, resulting in OS and DFS similar to those reported in developed countries.

DOI: 10.1182/blood-2012-08-449918

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@article{Rego2013ImprovingAP, title={Improving acute promyelocytic leukemia (APL) outcome in developing countries through networking, results of the International Consortium on APL.}, author={Eduardo M Rego and Haesook T Kim and Guillermo J Ruiz-Arg{\"{u}elles and Mar{\'i}a Soledad Undurraga and Maria del Rosario Uriarte and Rafael Henriques J{\'a}como and Homero Guti{\'e}rrez-Aguirre and Raul Antonio M. Melo and Rosane Isabel Bittencourt and Ricardo Pasquini and K{\'a}tia B{\'o}rgia Barbosa Pagnano and Evandro Maranh{\~a}o Fagundes and Maria de Lourdes Lopes Ferrari Chauffaille and Carlos S{\'e}rgio Chiattone and Lem Mart{\'i}nez and Luis Antonio Meillon and David G{\'o}mez-Almaguer and Hau C . Kwaan and Javier Garc{\'e}s-Eisele and Robert E. Gallagher and Charlotte Marie Niemeyer and Stanley L. Schrier and Martin S. Tallman and David J Grimwade and Arnold Ganser and Nancy Berliner and Raul C. Ribeiro and Francesco Lo-Coco and Bob L{\"{o}wenberg and Miguel {\'A}ngel Sanz}, journal={Blood}, year={2013}, volume={121 11}, pages={1935-43} }