Contributions
Abstract: EP476
Type: E-Poster Presentation
Session title: Acute myeloid leukemia - Clinical
Background
With the advance of diagnostic tools, standard of cares and therapeutic strategies, there is an obvious improvement in terms of overall survival and clinical responses in patients with acute promyelocytic leukemia (APL). In comparison with other hematological malignancy, APL has been now considered a highly curable disease, with 2-year event-free survival rates of 75–84%. Most cases achieved complete remission status after induction and consolidative therapies, which only required regular follow-up in outpatient department. In line with this, the incidence of second primary malignancies (SPMs) among APL survivors would be expected and investigated further.
Aims
Despite the fact two studies have reported the incidence and cancer types of SPM in APL patients, the data still remain unclear in Asia APL patients. We aim to investigate the incidence, types and possible risk factor of SPM comprehensively through a national wide database.
Methods
Through a longitudinal and nationwide database- the National Health Insurance database (NHIRD), totally 492 APL cases were enrolled into this retrospective analysis. SPM was investigated in different APL populations undergoing ATRA (vesanoid) alone or ATRA and ATO (arsenic trioxide) with/without chemotherapy. Additionally, in order to deciphering molecular association behind this notion, a public genomic database (GSE 155779) was utilized for further analysis the effect of these therapeutic agents in APL cases.
Results
Two different study groups were identified, which included the patients with APL undergoing ATO/ATRA or ATRA alone. In APL patients under ATO/ATRA or ATRA alone, SPM was identified in 30 out of 246 cases and 40 cases out of 246 cases in these study cohorts, respectively. Looking into detailed distribution of cancer types, SPM included malignant melanoma, breast, pancreatic, liver, lung, bladder and hematopoietic malignancy in both APL group. Intriguingly, the majority of SPM is acute lymphocytic leukemia in both study cohorts. GSEA analysis demonstrated gene signatures in terms of cytokine response, NF-kB inflammatory signaling and angiogenesis pathways are enriched positively in NB4 cells undergoing ATRA treatment compared to NB4 control groups. Surprisingly, MLL-AF4 fusion target gene signatures are also enriched in NB4 cells with ATRA treatment group, which indirectly unveiled a possible explanation regarding an increased incidence of ALL among APL patients treated with ATRA or ATRA/ATO in our study.
Conclusion
In the current study, our results raised a consideration regarding the incidence and detailed cancer types of SPM in APL cases. Otherwise, this study demonstrated a distinctive distribution of SPM compared to previous studies.
Keyword(s): Acute promyelocytic leukemia
Abstract: EP476
Type: E-Poster Presentation
Session title: Acute myeloid leukemia - Clinical
Background
With the advance of diagnostic tools, standard of cares and therapeutic strategies, there is an obvious improvement in terms of overall survival and clinical responses in patients with acute promyelocytic leukemia (APL). In comparison with other hematological malignancy, APL has been now considered a highly curable disease, with 2-year event-free survival rates of 75–84%. Most cases achieved complete remission status after induction and consolidative therapies, which only required regular follow-up in outpatient department. In line with this, the incidence of second primary malignancies (SPMs) among APL survivors would be expected and investigated further.
Aims
Despite the fact two studies have reported the incidence and cancer types of SPM in APL patients, the data still remain unclear in Asia APL patients. We aim to investigate the incidence, types and possible risk factor of SPM comprehensively through a national wide database.
Methods
Through a longitudinal and nationwide database- the National Health Insurance database (NHIRD), totally 492 APL cases were enrolled into this retrospective analysis. SPM was investigated in different APL populations undergoing ATRA (vesanoid) alone or ATRA and ATO (arsenic trioxide) with/without chemotherapy. Additionally, in order to deciphering molecular association behind this notion, a public genomic database (GSE 155779) was utilized for further analysis the effect of these therapeutic agents in APL cases.
Results
Two different study groups were identified, which included the patients with APL undergoing ATO/ATRA or ATRA alone. In APL patients under ATO/ATRA or ATRA alone, SPM was identified in 30 out of 246 cases and 40 cases out of 246 cases in these study cohorts, respectively. Looking into detailed distribution of cancer types, SPM included malignant melanoma, breast, pancreatic, liver, lung, bladder and hematopoietic malignancy in both APL group. Intriguingly, the majority of SPM is acute lymphocytic leukemia in both study cohorts. GSEA analysis demonstrated gene signatures in terms of cytokine response, NF-kB inflammatory signaling and angiogenesis pathways are enriched positively in NB4 cells undergoing ATRA treatment compared to NB4 control groups. Surprisingly, MLL-AF4 fusion target gene signatures are also enriched in NB4 cells with ATRA treatment group, which indirectly unveiled a possible explanation regarding an increased incidence of ALL among APL patients treated with ATRA or ATRA/ATO in our study.
Conclusion
In the current study, our results raised a consideration regarding the incidence and detailed cancer types of SPM in APL cases. Otherwise, this study demonstrated a distinctive distribution of SPM compared to previous studies.
Keyword(s): Acute promyelocytic leukemia