Acute Promyelocytic Leukemia: Impact of Hemorrhagic Complications on Response to Induction Chemotherapy and Survival

Humphries, John Eric; Hess, Charles E.; Stewart, F. Marc

doi:10.1097/00007611-199010000-00010

Cited by 17 publications

(16 citation statements)

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“…In addition, viral infection of brain endothelial cells has been thought to cause cerebral hemorrhages, 31 but this could not be confirmed clinically. Thrombocytopenia, or platelet counts ranging from 20 000 to 40 000/ml, has been found to be a cause of cerebral hemorrhages, 16,30,32,33 and several centers have a restrictive platelet transfusion policy, with thresholds at 10 000 to 20 000/ml for patients with acute leukemia. 34,35 In contrast, we found that platelet counts less than 35 000/ml increased the risk of FICH.…”

Section: Discussionmentioning

confidence: 99%

Risk score model for fatal intracranial hemorrhage in acute leukemia

Kim

et al. 2006

Leukemia

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To build a risk score (RS) model of fatal intracranial hemorrhage (FICH) in patients with acute leukemia, we retrospectively assessed risk factors in 792 patients newly diagnosed with acute leukemia, 41 of whom had analyzable FICH. We found that female gender (relative risk (RR) ¼ 5.234, Po0.001), acute promyelocytic leukemia (RR ¼ 4.057, P ¼ 0.003), leukocytosis (RR ¼ 3.301, P ¼ 0.004), thrombocytopenia (RR ¼ 3.283, P ¼ 0.005) and prolonged prothrombin time (RR ¼ 3.291, P ¼ 0.016) were significantly associated with occurrence of FICH in multivariate analysis. To calculate RS for FICH, one point was assigned for each risk factor, making the RS between 0 and 5. The RS model segregated patients into three prognostic groups: a low-risk group (LRG) for RS of 0 or 1; an intermediate-risk group (IRG) for RS of 2 or 3; and a high-risk group (HRG) for RS of 4 or 5. Expectation of FICH was well correlated with risk groups (all P-values o0.001). Overall survival was significantly shorter in the HRG compared with the LRG. The RS model we constructed to predict the occurrence of FICH will be verified through prospective studies.

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Section: Discussionmentioning

confidence: 99%

Risk score model for fatal intracranial hemorrhage in acute leukemia

Kim

et al. 2006

Leukemia

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“…Treatment-related mortality due to haemorrhage has, until recently, been a significant management problem [6,17,22,38,50].…”

Section: Introductionmentioning

confidence: 99%

Acute promyelocytic leukaemia: a retrospective analysis of patients treated at St. Bartholomew's Hospital 1969-1995

Slater

Carter

Howe

et al. 1999

Annals of Hematology

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Seventy-two patients with acute promyelocytic leukemia (APML) were treated at St.Bartholomew's Hospital (SBH) over a 25-year period. Improvements in supportive care and the use of more intensive chemotherapy have led to an increase in the complete remission rate from 14 to 58%. Similarly, the median survival has increased from 3 weeks to 2 years; the median duration of remission, which was 7 months in 1974, has not yet been reached. There was also a significant difference in survival from first recurrence, compared with that of patients with other subtypes of acute myeloid leukemia. RT-PCR analysis on bone marrow samples from 14 patients confirmed the presence of the PML/RARA fusion; 13 of the 14 patients achieved 'molecular remission' after therapy. The one patient who remained persistently positive experienced recurrence within 4 months. In seven of the eight patients in whom the disease recurred, the translocation was identified by RT-PCR at the time of relapse, whilst in one patient it was noted 4 months prior to morphological recurrence. These results illustrate the improvement in prognosis that occurred over a 25-year period in patients with APML treated at a single centre.

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“…Both patients with APL had the characteristic (15;17) translocation with a breakpoint on chromosome 17 in the region of the RAR alpha. Although APL is very sensitive to chemotherapy, up to 40% die of hemorrhagic complications [2,3]. The first patient was critically ill.…”

Section: Discussionmentioning

confidence: 99%

“…Although APL is sensitive to chemotherapy, the course of initial treatment is frequently complicated by severe coagulopathy. More than 90% of the patients show features of disseminated intravascular coagulation (DIC) and 2 0 4 0 % die early of fatal hemorrhage [2,3]. Bleeding diathesis is probably due to the release of procoagulatory and fibrinolytic substances from damaged leukemic cells [4].…”

Section: Introductionmentioning

confidence: 99%