AI Article Synopsis
- Acute promyelocytic leukemia (APL) is a specific type of acute myeloid leukemia (AML) that has distinct symptoms and outcomes, with this study focusing on the treatment and results for Thai patients primarily using all-trans-retinoic acid (ATRA) combined with chemotherapy.
- Over eight years, 79 newly diagnosed APL patients were analyzed from 992 AML cases, revealing that the majority were new cases rather than therapy-related, and a significant portion showed serious symptoms like disseminated intravascular coagulation.
- The study found a high complete response rate of 95.7%, with a four-year overall survival rate of 75.6%, but noted that older age and high white blood cell count negatively impacted survival outcomes
Article Abstract
Introduction: Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia (AML) with a unique clinical presentation and prognosis. This study aimed to investigate the epidemiology, clinical characteristics, treatments, and clinical outcomes of Thai APL patients dominantly treated with all-trans-retinoic acid (ATRA) combined with a chemotherapy-based therapy.
Methods: This was an eight-year prospective, observational study from nine academic hospitals in the Thai Acute Leukemia Working Group (TALWG) of the Thai Society of Hematology, which included newly diagnosed Thai APL patients, aged 18 years or older. The web-based registration collected baseline charateristic, and clinical outcomes.
Results: From 992 newly diagnosed AML patients, 79 APL patients were enrolled in this study. Almost all subjects were de novo APL (94.9%), while the others were therapy-related APL. The commonest clinical presentation was disseminated intravascular coagulation (38%). One-third of the patients were categorized as high risk according to the initial WBC. Almost all patients received ATRA combined with idarubicin regimen. The complete response rate was as high as 95.7%, which translated into excellent four-year overall survival (OS) (75.6%) and four-year leukemia-free survival (LFS) (75.4%). The multivariate analysis demonstrated that the older age and WBC count >20 × 10/L conferred a significantly unfavorable OS with the hazard ratios of 3.03 (95% confidence interval [CI]: 1.14-8.05) and 4.18 (95%CI: 1.69-10.35), respectively. Similarly, these two parameters remained independent of the poor prognosis factors for LFS.
Conclusion: This report confirmed that APL had a favorable prognosis. However, advanced age and high WBC count >20 × 10/L contributed to a worse outcome.
Abbreviations: APL; acute promyelocytic leukemia; ATRA; all-transretinoic acid; CR; complete remission; DS; differentiation syndrome; ECOG; Eastern Cooperative Oncology Group; ED; early death; HR; hazard ratio; IQR; interquartile range; LFS; leukemia-free survival; OS; overall survival; WBC; white blood cell.
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| http://dx.doi.org/10.1080/16078454.2023.2191462 | DOI Listing |
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