Addressing the room for improvement in management of acute promyelocytic leukemia

Nørgaard, Jan Maxwell; Friis, Lone S.; Kristensen, Jörgen; Severinsen, Marianne Tang; Mølle, Ingolf; Marcher, Claus Werenberg; Schoellkopf, Claudia; Nielsen, Ove Juul; Preiss, Birgitte; Andersen, Mette Klarskov; Kjeldsen, Eigil; Medeiros, Bruno C.; Østgård, Lene Sofie Granfeldt

doi:10.1111/ejh.13229

Cited by 5 publications

(5 citation statements)

References 32 publications

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“…However, age was not a risk factor for OS in our study. Similar to our result, the Danish Registry was reported that while the age is not an independent risk factor for OS, the performance status of the patients is the main determinant of OS [34]. This may reflect the importance of performance status rather than the age during the treatment process.…”

Section: Discussionsupporting

confidence: 89%

“…In the present study, we observed no improvement in 2-year OS rates from 2003-2009 to 2010-2016. Similarly, epidemiologic data demonstrated that there was no significant change in survival and remained relatively stable in recent years [16,34]. However, The International Consortium on Acute Promyelocytic Leukemia (IC-APL) demonstrated that the effort to recognize and treat APL early had been associated with significantly improved 2-year OS up to 80% in developing countries [35].…”

Section: Discussionmentioning

confidence: 99%

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Real-life outcomes of unselected acute promyelocytic leukemia patients: a single-center 14-year experience

Akcay

Yeter

Büyükaşık

2020

Romanian Journal of Internal Medicine

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Background: After the inclusion of all-trans retinoic acid (ATRA) into the treatment of Acute Promyelocytic leukemia (APL), a notable improvement concerning the survival rates of patients with APL has been observed. However, the population-based studies demonstrated that there was no marked improvement in the survival of patients after the 2000s. We aim to describe the clinical response and prognosis of adult patients diagnosed with APL and examine the change in these outcomes by the time period of diagnosis.Methods: We retrospectively reviewed thirty-six unselected APL patients who were diagnosed between September 2003 and February 2016.Results: The probability of survival at two years was 58%, while disease-free survival (DFS) was 87%. The overall early death (ED) rate was 33% and remain stable over time [42% in 2003-2009 vs. 24% in 2010-2016 (p=.20)]. In addition, the 2-year overall survival (OS) rates were 47% in 2003-2009 and 70% in 2010-2016 (p=.29), and no differences were noted. Univariate analyses showed possible predictors of poor OS were defined as leukocytosis (≥10x109/L), high Sanz score, hemorrhage, infection, disseminated intravascular coagulopathy (DIC) at presentation and microgranular morphologic subtype.Conclusion: This study shows that long-term survival remains low in APL patients, particularly related to a high ED rate. Initiatives to reduce ED are exceedingly substantial for improving the survival in APL.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Real-life outcomes of unselected acute promyelocytic leukemia patients: a single-center 14-year experience

Akcay

Yeter

Büyükaşık

2020

Romanian Journal of Internal Medicine

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“…Another study investigated the incidence, treatment, ED rate and long term clinical outcome of APL patients. Twenty two of 41 deaths occurring in 122 APL patients were EDs which were primarily caused by intracranial hemorrhage, DIC, sepsis and multiorgan failure [8]. Contrasting to the life-threatening initial phase of APL, patients surviving this critical period have superior outcomes characterized by low relapse risk and high survival rates than other AML subtypes [9].…”

Section: Introductionmentioning

confidence: 99%

The factors affecting early death in newly diagnosed APL patients

et al. 2019

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AbstractBackground and aimIn the past, acute promyelocytic leukemia (APL) was considered as one of the most rapidly lethal form of acute myeloid leukemia (AML). The objective of this study was to assess clinical parameters affecting early death (ED) in patients with APL.Materials and methodsForty-three patients with APL who were diagnosed at Hacettepe University Hospital between the years of 2005 and 2018 were evaluated.ResultsIn univariate analyses, presentation with hemorrhage, DIC or infection at diagnosis, ECOG performance score, blast percentage on bone marrow, Sanz score, leukocyte, thrombocyte, fibrinogen and LDH levels were found to be statistically significantly different between patients with ER and patients without ED. In multivariate analysis, presentation with hemorrhage, DIC or infection at diagnosis, ECOG performance score, blast percentage on bone marrow, Sanz score, leukocyte, thrombocyte, fibrinogen, and LDH levels were found to be independent factors that are related with higher rate of ED in 30 days after treatment.ConclusionInduction chemotherapy should be started as soon as possible after diagnosis of APL. Improving ED rates may become the greatest challenge for the future treatment of the diseases.

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“…APL has evolved from being a deadly to a highly curable disease. [3][4][5][6][7][8][9][10][11][12][13] Despite advances in the treatment of APL, early death rates have remained relatively constant. Hemorrhagic complications are the most common cause of early death in patients with APL and remain a major challenge in the management of APL.…”

Section: Introductionmentioning

confidence: 99%

“…APL has evolved from being a deadly to a highly curable disease. 3–13 …”

Section: Introductionmentioning

confidence: 99%

Absolute Circulating Leukemic Cells as a Risk Factor for Early Bleeding Events in Patients with Non-High-Risk Acute Promyelocytic Leukemia

Pei¹,

Shi²,

Song³

et al. 2021

CMAR

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Background: Hemorrhagic complications are the most common cause of early death in patients with APL and remain a major challenge in the management of APL. Early fatal bleeding events occur not only in high-risk but also in non-high-risk acute promyelocytic leukemia (APL) patients with normal or low WBC counts. Objectives and Methods: To demonstrate the role of the absolute number of circulating leukemic cells in early bleeding events in APL patients. Clinical and laboratory characteristics of 149 patients newly diagnosed with APL were obtained from medical records and retrospectively investigated. Results: In this study, circulating absolute leukemic cells were positively correlated with the WBC count (r=0.9813, p<0.001) in all patients with APL, and importantly, they were strongly associated with significant bleeding events in non-high-risk patients. Multivariate logistic regression analysis showed that the absolute number of leukemia cells was an independent risk factor for significant bleeding events in APL patients. A cut-off value of 2.59×10 9 /L for circulating leukemic cells to predict significant bleeding events in APL patients was obtained by ROC curve analysis. We further confirmed that the significant bleeding rate of patients with non-high-risk APL was statistically increased when the absolute number of circulating leukemic cells was ≥2.59×10 9 /L. Conclusion: Circulating leukemic cell content has great clinical value for predicting early bleeding events in APL patients, especially in non-high-risk APL.

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Addressing the room for improvement in management of acute promyelocytic leukemia

Cited by 5 publications

References 32 publications

Real-life outcomes of unselected acute promyelocytic leukemia patients: a single-center 14-year experience

Real-life outcomes of unselected acute promyelocytic leukemia patients: a single-center 14-year experience

The factors affecting early death in newly diagnosed APL patients

Absolute Circulating Leukemic Cells as a Risk Factor for Early Bleeding Events in Patients with Non-High-Risk Acute Promyelocytic Leukemia

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