Age and treatment were independently associated with survival outcomes in patients with acute promyelocytic leukemia (APL) in a German cohort analysis.
Specifically, the introduction of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) has improved overall survival regardless of age, but survival rates are significantly impacted by age, according to David Baden, MD, of the University Hospital Schleswig-Holstein and Christian-Albrechts-University, and colleagues, who published their findings in a Letter to the Editor in Haematologica.
The analysis included patients with APL who were newly diagnosed between 2016 and 2021 from the German federal cancer registries and the Center for Cancer Registry Data. During that time, 649 patients (2.5%) with acute myeloid leukemia were diagnosed with APL. The median age at diagnosis was 55.6 years. The age-standardized incidence rate was stable during this study period.
Survival data were available for 450 patients after a median follow-up of 35.5 months.
OS was 76.7% at three years and 75.2% at five years. Survival did not differ between male and female patients but was “markedly” different by age, with five-year OS rates of:
- 87.9% in those aged 0-59 years
- 70.8% in those aged 60-74 years
- 25.7% in those aged older than 75 years
About half of patients (n=232; 51.5%) were treated with ATO/ATRA alone, while 86 (19.1%) underwent intensified therapy with chemotherapy in addition to ATO and/or ATRA.
OS was most favorable for those receiving ATO/ATRA, with a three-year OS of 87.3% compared with 77.4% in those receiving chemotherapy plus ATO and/or ATRA and 49.2% for those receiving intensive therapy without ATO/ATRA.
Early mortality—defined as within 60 days of diagnosis—was highest in those receiving intensive chemotherapy (29.2%) and lowest in those treated with ATO/ATRA (7.8%).
The study is limited by its use of information from a database.
“Our results indicate that both clinical expertise and robust care pathways, ensuring quick diagnosis and initiation of ATO/ATRA therapy, are likely key determinants of the high survival rates among patients with APL,” the authors noted. “We recommend connecting specialized primary care centers with secondary and tertiary providers, and using telemedicine and other collaborative approaches to enable rapid testing, timely blood product use, and optimal management of differentiation syndrome.”
Reference
Baden D, Wolgast N, Ruhnke L, et al. Nationwide analysis of acute promyelocytic leukemia: incidence and patient outcomes in Germany. Haematologica. 2026;111(8):2843-2847. doi:10.3324/haematol.2025.300427
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