Acute promyelocytic leukemia in 57 previously untreated patients

Abstract

Fifty‐seven patients in initial phase of acute promyelocytic leukemia (APL) were treated in the same department with heparin infusion, platelet transfusions, and two related induction regimens both including cytosine arabinoside and daunorubicin. Clinical and biological findings at presentation were studied. The complete remission (CR) rate was 53%. Twenty‐seven patients (47%) died during the initial course of the disease, either before day 5 (early death [ED], n = 7) or after day 5 (death in aplasia [DA], n = 20). Most ED was due to intracerebral hemorrhage (6/7), especially when large hemorrhages had been seen on fundus oculi examination. Most DA was due to multivisceral failure (9/20). No correlation was found between initial disseminated intravascular coagulation (DIC) and death. However, the worsening of coagulation parameters during induction therapy, with or without initial DIC, significantly increased the occurrence of renal and respiratory failure which were particularly frequent during the first month. The median duration of survival was short (3.5 months) and the median duration of CR (11 months) was similar to that of other acute myeloid leukemias treated with the same regimens. The possible causes of the high mortality observed during the initial courses of APL and the possible benefit of a more graduate induction chemotherapy are discussed.

Effect of all-trans retinoic acid on newly diagnosed acute promyelocytic leukemia patients: results of a Brazilian center

“…This study shows the differentiating capacity of ATRA as an inductor of CR, with 83.7% of the newly diagnosed patients achieving CR during the course of treatment. Such remission rates are similar to those obtained in several other randomized trails with ATRA (4,10) and also to the historical results obtained with standard chemotherapy (11).…”

“…Furthermore, the leukemic blasts can infiltrate the arteriolar endothelial walls and cause a secondary hemorrhage (15). Therefore, a major concern about APL patients treated with ATRA is early death secondary to hyperleukocytosis during induction treatment (11,16), especially due to RAS and intracerebral hemorrhage. In our study, 4 of 37 patients (11%) had an early death due to intracerebral hemorrhage, with a higher median WBC than in the group that did not develop this lethal complication (48 x 10 3 /mm 3 versus 22.5 x 10 3 /mm 3 ).…”

Risk score model for fatal intracranial hemorrhage in acute leukemia

“…20,23,[39][40][41][42][43] In contrast to the improvement in survival and decrease of hemorrhagic complications resulting from the introduction of ATRA, changes in hemorrhagic mortality have been reported to be minimal. 10 In our study, FICH was not decreased after ATRA use (data not shown).…”

Hypofibrinogenemia in non-M3 acute myeloid leukemia. Incidence, clinical and laboratory characteristics and prognosis

“…3,11,12 The major reason for the bleeding tendency is the disease-and treatment-related thrombocytopenia. Hypofibrinogenemia is a well known and threatening complication of APL.…”

“…[1][2][3][4][5] It was a frequent cause of serious bleeding before introduction of treatment with all-trans retinoic acid (ATRA). A coagulation disorder similar to that in APL may also occur in other FAB types of AML, but only a few data are available on the incidence in various FAB types, the risk of bleeding and the prognosis of these patients.…”