Arsenic Trioxide and Chemotherapy Quality of Life Outcomes in Acute Promyelocytic Leukemia

By Patrick Daly - Last Updated: December 7, 2021

In a follow-up to the randomized controlled trial APL0406, researchers compared long-term health-related quality of life of patients with acute promyelocytic leukemia (APL) who were treated with either all-trans retinoic acid (ATRA) plus arsenic trioxide (ATO), or ATRA plus standard chemotherapy. Their article, published in Blood Advances, reported that ATRA-ATO appeared to have a greater and more sustained antileukemic effect, and was also associated with better patient-reported long-term quality of life outcomes than ATRA chemotherapy.

Notably, in response to previous data that suggested a different profile of complications between ARTA-ATO and ATRA chemotherapy, the study’s lead author, Fabio Efficace, PhD, wrote that their results suggested that the two treatments “do not translate into a different proportion of late health problems and comorbidities.

A total of 161 patients previously enrolled in the APL0406 trial were analyzed. Eighty-three had been treated with ATRA-ATO and 78 with ATRA chemotherapy, and the median time since diagnosis was eight years. Patient-reported outcomes were assessed via the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core30 (EORTC QLQ-C30), the EORTC Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy 20 (QLQ-CIPN20), and the Short Form Health Survey 36 (SF-36).

Among EORTC QLQ-C30 responses, patients treated with ATRA-ATO had clinically meaningful score differences in role functioning (? = 8.4; 95% confidence interval [CI], 0.5–16.3), and dyspnea (? = ?8.5, 95% CI, ?16.4 to ?0.7), compared to patients treated with ATRA chemotherapy. Regarding SF-36 results, patients treated with ATRA-ATO displayed a better physical component score (? = 4.6; 95% CI, 1.3–7.8), although differences in mental component score were not clinically relevant. Otherwise, the two patient groups had similar EORTC QLQ-CIPN20 scores and late comorbidities.

The authors acknowledged that they did not use a questionnaire specific for patients with AML or APL, which may have limited the scope of their analysis. They noted that HRQoL reporting tools specific to these patients have only recently been published, however.

Dr. Efficace concluded that the better physical health and fewer daily activity limitation outcomes observed in patients previously treated with intravenous ATRA-ATO—compared to standard chemotherapy—support the use of the treatment as a first-line therapy in nonhigh-risk patients with APL