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- Title
Clinical characteristics and outcomes in patients with acute promyelocytic leukaemia and hyperleucocytosis.
- Authors
Daver, Naval; Kantarjian, Hagop; Marcucci, Guido; Pierce, Sherry; Brandt, Mark; Dinardo, Courtney; Pemmaraju, Naveen; Garcia‐Manero, Guillermo; O'Brien, Susan; Ferrajoli, Alessandra; Verstovsek, Srdan; Popat, Uday; Hosing, Chitra; Anderlini, Paolo; Borthakur, Gautam; Kadia, Tapan; Cortes, Jorge; Ravandi, Farhad
- Abstract
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 × 109/l at presentation (median WBC 85·5 × 109/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.
- Subjects
ACUTE leukemia; LEUCOCYTOSIS; LEUKOCYTE count; LEUKAPHERESIS; ARSENIC trioxide; ANTINEOPLASTIC agents; IDARUBICIN; PATIENTS
- Publication
British Journal of Haematology, 2015, Vol 168, Issue 5, p646
- ISSN
0007-1048
- Publication type
Article
- DOI
10.1111/bjh.13189