Treatment advances have not improved the early death rate in acute promyelocytic leukemia

Abstract

Early mortality in acute promyelocytic leukemia has been reported to occur in less than 10% of patients treated in clinical trials. This study reports the incidence and clinical features of acute promyelocytic leukemia patients treated at Stanford Hospital, CA, USA since March 1997, focusing on early mortality. We show that the risk of early death in acute promyelocytic leukemia patients is higher than previously reported. In a cohort of 70 patients who received induction therapy at Stanford Hospital, 19% and 26% died within seven and 30 days of admission, respectively. High early mortality was not limited to our institution as evaluation of the Surveillance, Epidemiology and End Results Database demonstrated that 30-day mortality for acute promyelocytic leukemia averaged 20% from 1977-2007 and did not improve significantly over this interval. Our findings show that early death is now the greatest contributor to treatment failure in this otherwise highly curable form of leukemia. The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database is a compilation of cancer registries that covered more than a quarter of the U.S. population. 16Using the SEER*Stat 6.6.2 software package and the SEER 17 database, 30-day death rates and 3-year survival data were obtained for APL patients aged 15 years and older. Relapse cases and cases diagnosed only at autopsy were excluded.

High efficacy of arsenic trioxide plus all-trans retinoic acid based induction and maintenance therapy in newly diagnosed acute promyelocytic leukemia

“…Induction failure of patients is generally related to early mortality. Early mortality is now considered one of the most critical issues in the current treatment of patients with APL [30,31]. It indicated that current interventions to prevent early death are still not adequate.…”

Prognostic factors in acute promyelocytic leukemia: strategies to define high-risk patients

“…Furthermore, older age was found to be a prognostic factor of early death in all published APL series [30, [65][66][67][68].…”

Acute myeloid leukemia in the real world: why population-based registries are needed

“…23 Subsequently, our findings on the early death rates have been confirmed in the large but less-detailed SEER registry, 21,59 and from a single institution study. 60 Obviously, the older patients and those with severe initial symptoms and high risk of early death did not enter the clinical studies and were not identified in the large multicenter trials. Our findings from the Swedish registry emphasize that the most important area for improved management in APL is now early detection and intensified supportive care, especially in the significant fraction of patients older than 60 years, rather than changes in consolidation treatment and maintenance.…”