Management of APL in Developing Countries: Epidemiology, Challenges and Opportunities for International Collaboration

Abstract

Acute promyelocytic leukemia (APL), a relatively rare hematologic malignancy, is highly curable with current treatment strategies. However, these strategies may be unavailable in countries with limited resources. A review of records in several Latin American countries revealed that approximately 30% of deaths among children and adults with APL were caused by early complications associated with the disease or its treatment. Further, APL accounts for 20% to 25% of cases of AML in these countries, consistent with the previous observation of increased incidence of APL in Latin Americans. The lack of population-based registries in developing countries has made it difficult to determine the real incidence of APL. Moreover, APL appears to have other unique epidemiologic characteristics, including association of primary APL with an increased body mass index at diagnosis and association of secondary APL with breast cancer. To facilitate the development of local capacity and implement effective treatment of APL in developing countries, the International Committee of the American Society of Hematology has assembled a working group to formulate treatment guidelines based on evidence from clinical trials results in the developed world but adapted to local resources. It is hoped that uniform treatment, careful documentation of specific outcome data, and ongoing monitoring of treatment efficacy and toxicity will improve the cure rate and provide biologic and epidemiologic information about APL in developing countries. This initial demonstration project may be joined by other countries, providing a framework for additional clinical investigation in this highly curable form of leukemia.

Disseminated intravascular coagulation in acute promyelocytic leukaemia and its impact on the induction failure: a single centre study

“…WBC count more than 10x 10 9 /L and platelet count less than 40x10 9 /L individually has positive relationship with induction mortality. In the context of our setting management of DIC in higher risk group is more challenging than that of in low risk group as because presence of high WBC count and low platelet count in association with DIC is more difficult to manage in countries with limited resourses where prompt diagnosis, supportive management and patient monitoring is inadequate 12 . So it may lead to the conclusion that presence of DIC among high risk group is responsible for the main burden of induction failure where aggressive supportive care is needed and management of this remains the main challenge for us.…”

Transcriptomics and proteomics in studies of induced differentiation of leukemia cells

“…Острый промиелоцитарный лейкоз (ОПЛ) -одна из форм острого миелоидного лейкоза, на долю которого приходится 5-15% случаев лейкозов у взрослых [1]. Долгое время ОПЛ отличался высокой степенью злокачественности, вследствие развития опасных для жизни кровотечений, обусловленных тромбоцитопенией или синдромом диссеминированного внутрисосудистого свёртывания [2].…”

Retrospective analysis of 119 cases of pediatric acute promyelocytic leukemia: Comparisons of four treatment regimes

“…Recently a study on childhood AML in Japan reported a 93.1% overall survival (OS) rate and 94% EFS rate for patients 6 and RUN-MING JIN treated with ATRA, anthracyclines and cytarabine (at both the induction and consolidation stages) (16). Despite of the reported high survival rate, the outcome of APL treatment in many developing countries including China appears to vary dramatically, largely depending on how the therapeutic regimes are designed and delivered (14,18). A study based in Taiwan reported that the overall survival and EFS of 6 APL children treated with ATRA during induction were 83 and 67%, respectively (19).…”