AI Article Synopsis
- About 10% of patients with acute promyelocytic leukaemia (APL) die during treatment due to severe bleeding issues linked to coagulopathy.
- The coagulopathy in APL is complicated, involving factors like tissue factor (TF) and cancer procoagulant (CP) that trigger widespread clotting, along with enhanced breakdown of clots due to changes in APL cells.
- All-trans retinoic acid (ATRA) has significantly improved APL treatment, leading to a long-term survival rate of about 80% when used with chemotherapy by promoting differentiation of APL cells and reducing bleeding risks through several mechanisms.
Article Abstract
Despite the development of highly effective treatment strategies for acute promyelocytic leukaemia around 10% of patients die in the presentation period as a consequence of the associated bleeding diathesis. The cause of the coagulopathy is complex resulting from a combination of tissue factor (TF) and cancer procoagulant (CP) induced disseminated intravascular coagulation, exaggerated fibrinolysis due predominantly to enhanced expression of annexin II on APL blast cell membranes and blast cell production of cytokines. All-trans retinoic acid (ATRA) has revolutionised the treatment of APL. When combined with chemotherapy long term survival rates of up to 80% can be achieved. Commencement of ATRA induces APL blast cell differentiation and is associated with a rapid resolution of the bleeding tendency through a combination of effects which include up regulation of thrombomodulin and down regulation of TF and CP production and cell surface expression of annexin II.
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| http://dx.doi.org/10.1016/j.blre.2006.04.001 | DOI Listing |
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