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A letter to the editor is presented regarding the somatic mutations of the colony-stimulating factor-3 receptor gene (CSF3R), which can be identified in patients with chronic myelomonocytic leukemia (CMML).

Incidence on relapse and nonrelapse mortality (NRM) of chronic graft-versus-host disease (GVHD), per National Institutes of Health (NIH) criteria, is not well defined after reduced-intensity conditioning (RIC) regimens. We analyzed the association of chronic GVHD with the risk of relapse and NRM using Cox models in 177 consecutive patients who underwent transplantation for hematological malignancies after RIC. The cumulative incidence of chronic GVHD at 36 months was 74% when using Seattle's criteria compared with 54% with NIH consensus. In Cox model, NRM was significantly higher in patients with late-onset, persistent and recurrent acute GVHD (hazard ratio (HR): 6, 25 and 11; P=0.014, P<0.0001, P<0.0001, respectively). The cumulative incidence of relapse was significantly decreased in patients with chronic GVHD compared with no GVHD group using either Seattle's or NIH criteria (HR 0.43 and 0.38; P=0.022 and 0.016, respectively), whereas the presence of late-onset, persistent and recurrent acute GVHD was not associated with a decreased rate of relapse (HR: not significant, 0.70 and 0.71; P=not significant, P=0.73 and P=0.54, respectively). Chronic GVHD per NIH consensus definition is associated with the graft-versus-tumor effect, whereas all forms associated with acute features beyond day 100 are associated with NRM. [ABSTRACT FROM AUTHOR]

Acute promyelocytic leukaemia (APL) accounts for approximately 8% of all acute myeloid leukemias (AML) in adults. APL is characterized by a t(15;17) chromosomal translocation, a strong tendency for bleeding at diagnosis, and a sensitivity to those agents that induce a differentiation of leukaemia blasts such as all-trans retinoic acid (ATRA) or arsenic. Combined ATRA and chemotherapy have significantly improved patient outcome, with a rate of relapse that has been reduced to approximately 15%. Today, arsenic is being used successfully to treat relapsed patients; its high efficacy allows undertaking haematopoietic stem cell transplantation and achieving second full remission. Other new agents also exhibit high efficacy in APL, which makes this type of AML, considered fearsome for long, a subset for which there are a lot of therapeutic options and satisfactory therapeutic outcome. [ABSTRACT FROM AUTHOR]

We analyzed the incidence, presenting features, risk factors of extramedullary (EM) relapse occurring in acute promyelocytic leukemia (APL) treated with all-trans retinoic acid (ATRA) and chemotherapy by using a competing-risk method. In total, 740/806 (92%) patients included in three multicenter trials (APL91, APL93 trials and PETHEMA 96) achieved CR, of whom 169 (23%) relapsed, including 10 EM relapses. Nine relapses involved the central nervous system (CNS) and one the skin, of which two were isolated EM relapse. In patients with EM disease, median WBC count was 26 950/mm3 (7700–162 000). The 3-year cumulative incidence of EM disease at first relapse was 5.0%. Univariate analysis identified age <45 years (P=0.05), bcr3 PML-RARα isoform (P=0.0003) and high WBC counts (10 000/mm3) (P<0.0001) as risk factors for EM relapse. In multivariate analysis, only high WBC count remained significant (P=0.001). Patients with EM relapse had a poorer outcome since median survival from EM relapse was 6.7 months as compared to 26.3 months for isolated BM relapse (P=0.04). In conclusion, EM relapse in APL occurs more frequently in patients with increased WBC counts (10 000/mm3) and carries a poor prognosis. Whether CNS prophylaxis should be systematically performed in patients with WBC 10 000/mm3 at diagnosis remains to be established.Leukemia (2006) 20, 35–41. doi:10.1038/sj.leu.2404006; published online 24 November 2005 [ABSTRACT FROM AUTHOR]

We analyzed the outcome of patients aged more than 60 included in a multicenter trial in newly diagnosed acute promyelocytic leukemia (APL93 trial), which tested the role of early addition of chemotherapy to all trans retinoic acid (ATRA) and of maintenance with ATRA and/or low-dose chemotherapy. In total, 129/533 (24.2%) patients included in this trial were older than 60. The CR rate was 86%in patients older than 60 as compared to 94.5%in younger patients (P=0.0014), due to a higher incidence of early deaths in elderly patients. The 4-year incidence of relapse was 15.6%in adults older than 60 and 23.2%in younger adults although most elderly patients received less intensive consolidation chemotherapy. However, 18.6%of the patients older than 60 years who achieved CR died in CR, mainly from sepsis during consolidation course or maintenance treatment, as compared to 5.7%of younger adults (P<0.001). Thus, overall 4-year survival of elderly patients was 57.8%as compared to 78%in younger adults (P<0.0001). APL in elderly patients appears as sensitive to ATRA-Chemotherapy based regimen as in younger adults. Less favorable outcome is mainly due to an increase of early deaths and to toxicity of consolidation treatment, strongly suggesting a beneficial role for less intensive consolidation chemotherapy and possibly introduction of arsenic derivates in the treatment of APL in the elderly.Leukemia (2005) 19, 230-233. doi:10.1038/sj.leu.2403597 Published online 25 November 2004 [ABSTRACT FROM AUTHOR]