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Clinical characteristics and outcomes in patients with acute promyelocytic leukaemia and hyperleucocytosis
Author(s) -
Daver Naval,
Kantarjian Hagop,
Marcucci Guido,
Pierce Sherry,
Brandt Mark,
Dinardo Courtney,
Pemmaraju Naveen,
GarciaManero Guillermo,
O'Brien Susan,
Ferrajoli Alessandra,
Verstovsek Srdan,
Popat Uday,
Hosing Chitra,
Anderlini Paolo,
Borthakur Gautam,
Kadia Tapan,
Cortes Jorge,
Ravandi Farhad
Publication year - 2015
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.13189
Subject(s) - medicine , leukapheresis , idarubicin , arsenic trioxide , acute promyelocytic leukemia , gastroenterology , gemtuzumab ozogamicin , leukostasis , chemotherapy , surgery , complete remission , leukemia , retinoic acid , cd33 , stem cell , apoptosis , biochemistry , chemistry , genetics , cd34 , gene , biology
Summary The clinical characteristics, treatment options and outcomes in patients with acute promyelocytic leukaemia ( APL ) and hyperleucocytosis remain poorly defined. This study reviewed 242 consecutive patients with APL ; 29 patients (12%) had a white blood cell count ( WBC ) ≥ 50 × 10 9 /l at presentation (median WBC 85·5 × 10 9 /l). Patients with hyperleucocytosis had inferior complete remission ( CR ) rates (69% vs. 88%; P = 0·004) and higher 4‐week mortality (24% vs. 9%; P = 0·018) compared to patients without hyperleucocytosis. We noted a trend towards inferior 3‐year disease‐free survival ( DFS ) (69% vs. 80%; P = 0·057) and inferior 3‐year overall survival ( OS ) (74% vs. 92%; P = 0·2) for patients with hyperleucocytosis. Leukapheresis was performed in 11 (38%) of the 29 patients with hyperleucocytosis. CR rate and 3‐year OS were not significantly improved in patients who received leukapheresis. CR rate and 3‐year OS for the 15 patients with hyperleucocytosis treated with all‐trans retinoic acid ( ATRA ) plus arsenic trioxide ( ATO ) plus cytotoxic therapy (idarubicin or gemtuzumab ozogamicin) combinations were 100% and 100% vs. 57% and 35% for the 14 patients treated with non‐ ATRA / ATO combinations ( P = 0·004 and P = 0·002). Leukapheresis does not improve the outcomes in patients with APL presenting with hyperleucocytosis. ATRA / ATO ‐based combinations are superior to other regimens in these patients.