ACUTE PROMYELOCYTIC LEUKEMIA: A CONTEMPORARY SINGLE-INSTITUTION EXPERIENCE
(Abstract release date: 05/19/16)
EHA Library. Hessenauer M. 06/09/16; 134563; PB1663
Dr. Michael Hessenauer
Contributions
Contributions
Abstract
Abstract: PB1663
Type: Publication Only
Background
Acute promyelocytic leukemia (APL) is a rare hematologic malignancy, with an incidence of 600-800 cases per year in the United States. At our institution, fewer than 10 patients with a new diagnosis of acute promyelocytic leukemia are treated each year.
Aims
We aim to describe our experience with patients treated for acute promyelocytic leukemia at our institution over the last 15 years.
Methods
After Mayo Clinic institutional review board approval, we searched our institutional electronic database for those 18 years and older with a new diagnosis of acute promyelocytic leukemia between January 1, 2000 and December 31, 2015. We meticulously gathered all patient information through electronic chart review.
Results
Out of a total of 89 patients reviewed, 59 patients had complete data available. The median age at diagnosis was 61 years (range: 18-80 years). 34 patients were male, and 25 were female. 9 patients (15.3%) presented with high-risk disease, 27 (45.8%) had intermediate-risk disease, and 23 (39.0%) had low-risk disease. 5 patients (8.5%) had received chemotherapy for prior malignancies. 50 patients (84.7%) received ATRA with anthracycline-based chemotherapy, and 9 received ATRA and arsenic induction. 58 of 59 (98.3%) patients achieved complete remission after induction chemotherapy. One patient died during induction due to diffuse alveolar hemorrhage. After a median follow-up of 51 months (range: 1-180 months), 53 of 59 (89.8%) patients remain alive. 2 patients died of causes related to APL, 1 of a non-APL-related cause, and 3 died of unknown causes. Among 9 patients treated with ATRA and arsenic induction, all achieved complete remission and were alive at the time of last follow-up. 28 patients (47.5%) presented with disseminated intravascular coagulation (DIC) at diagnosis. Out of 28 patients with DIC, 9 (32.1%) experienced hemorrhage, and 19 (67.9%) experienced thrombotic events. 23 of 59 patients (40.0%) developed differentiation syndrome; 3 of 9 patients (33.3%) treated with arsenic and 20 of 50 patients (40.0%) treated with chemotherapy. 6 of the 9 patients (66.7%) treated with ATRA-arsenic had grade 3 or 4 neutropenia for 15 days or more during induction therapy. 46 of 50 patients (92.0%) treated with ATRA-chemotherapy had grade 3 or 4 neutropenia during induction. Infection was documented during induction therapy in 5 of 9 patients (55.6%) treated with arsenic and 26 of 50 patients (52.0%) receiving chemotherapy. 4 of the 6 patients (66.7%) who developed hepatic toxicity were receiving arsenic. Overall, 7 of 59 patients (11.9%) have relapsed, and 10 of 59 patients (16.9%) developed a secondary malignancy in our cohort.
Conclusion
Herein, we summarize our single-institution experience with acute promyelocytic leukemia treated over the last fifteen years. A comparison of the adverse events and efficacy of ATRA and chemotherapy versus ATRA and arsenic needs further exploration.
Session topic: E-poster
Keyword(s): Acute promyelocytic leukemia
Type: Publication Only
Background
Acute promyelocytic leukemia (APL) is a rare hematologic malignancy, with an incidence of 600-800 cases per year in the United States. At our institution, fewer than 10 patients with a new diagnosis of acute promyelocytic leukemia are treated each year.
Aims
We aim to describe our experience with patients treated for acute promyelocytic leukemia at our institution over the last 15 years.
Methods
After Mayo Clinic institutional review board approval, we searched our institutional electronic database for those 18 years and older with a new diagnosis of acute promyelocytic leukemia between January 1, 2000 and December 31, 2015. We meticulously gathered all patient information through electronic chart review.
Results
Out of a total of 89 patients reviewed, 59 patients had complete data available. The median age at diagnosis was 61 years (range: 18-80 years). 34 patients were male, and 25 were female. 9 patients (15.3%) presented with high-risk disease, 27 (45.8%) had intermediate-risk disease, and 23 (39.0%) had low-risk disease. 5 patients (8.5%) had received chemotherapy for prior malignancies. 50 patients (84.7%) received ATRA with anthracycline-based chemotherapy, and 9 received ATRA and arsenic induction. 58 of 59 (98.3%) patients achieved complete remission after induction chemotherapy. One patient died during induction due to diffuse alveolar hemorrhage. After a median follow-up of 51 months (range: 1-180 months), 53 of 59 (89.8%) patients remain alive. 2 patients died of causes related to APL, 1 of a non-APL-related cause, and 3 died of unknown causes. Among 9 patients treated with ATRA and arsenic induction, all achieved complete remission and were alive at the time of last follow-up. 28 patients (47.5%) presented with disseminated intravascular coagulation (DIC) at diagnosis. Out of 28 patients with DIC, 9 (32.1%) experienced hemorrhage, and 19 (67.9%) experienced thrombotic events. 23 of 59 patients (40.0%) developed differentiation syndrome; 3 of 9 patients (33.3%) treated with arsenic and 20 of 50 patients (40.0%) treated with chemotherapy. 6 of the 9 patients (66.7%) treated with ATRA-arsenic had grade 3 or 4 neutropenia for 15 days or more during induction therapy. 46 of 50 patients (92.0%) treated with ATRA-chemotherapy had grade 3 or 4 neutropenia during induction. Infection was documented during induction therapy in 5 of 9 patients (55.6%) treated with arsenic and 26 of 50 patients (52.0%) receiving chemotherapy. 4 of the 6 patients (66.7%) who developed hepatic toxicity were receiving arsenic. Overall, 7 of 59 patients (11.9%) have relapsed, and 10 of 59 patients (16.9%) developed a secondary malignancy in our cohort.
Conclusion
Herein, we summarize our single-institution experience with acute promyelocytic leukemia treated over the last fifteen years. A comparison of the adverse events and efficacy of ATRA and chemotherapy versus ATRA and arsenic needs further exploration.
Session topic: E-poster
Keyword(s): Acute promyelocytic leukemia
Abstract: PB1663
Type: Publication Only
Background
Acute promyelocytic leukemia (APL) is a rare hematologic malignancy, with an incidence of 600-800 cases per year in the United States. At our institution, fewer than 10 patients with a new diagnosis of acute promyelocytic leukemia are treated each year.
Aims
We aim to describe our experience with patients treated for acute promyelocytic leukemia at our institution over the last 15 years.
Methods
After Mayo Clinic institutional review board approval, we searched our institutional electronic database for those 18 years and older with a new diagnosis of acute promyelocytic leukemia between January 1, 2000 and December 31, 2015. We meticulously gathered all patient information through electronic chart review.
Results
Out of a total of 89 patients reviewed, 59 patients had complete data available. The median age at diagnosis was 61 years (range: 18-80 years). 34 patients were male, and 25 were female. 9 patients (15.3%) presented with high-risk disease, 27 (45.8%) had intermediate-risk disease, and 23 (39.0%) had low-risk disease. 5 patients (8.5%) had received chemotherapy for prior malignancies. 50 patients (84.7%) received ATRA with anthracycline-based chemotherapy, and 9 received ATRA and arsenic induction. 58 of 59 (98.3%) patients achieved complete remission after induction chemotherapy. One patient died during induction due to diffuse alveolar hemorrhage. After a median follow-up of 51 months (range: 1-180 months), 53 of 59 (89.8%) patients remain alive. 2 patients died of causes related to APL, 1 of a non-APL-related cause, and 3 died of unknown causes. Among 9 patients treated with ATRA and arsenic induction, all achieved complete remission and were alive at the time of last follow-up. 28 patients (47.5%) presented with disseminated intravascular coagulation (DIC) at diagnosis. Out of 28 patients with DIC, 9 (32.1%) experienced hemorrhage, and 19 (67.9%) experienced thrombotic events. 23 of 59 patients (40.0%) developed differentiation syndrome; 3 of 9 patients (33.3%) treated with arsenic and 20 of 50 patients (40.0%) treated with chemotherapy. 6 of the 9 patients (66.7%) treated with ATRA-arsenic had grade 3 or 4 neutropenia for 15 days or more during induction therapy. 46 of 50 patients (92.0%) treated with ATRA-chemotherapy had grade 3 or 4 neutropenia during induction. Infection was documented during induction therapy in 5 of 9 patients (55.6%) treated with arsenic and 26 of 50 patients (52.0%) receiving chemotherapy. 4 of the 6 patients (66.7%) who developed hepatic toxicity were receiving arsenic. Overall, 7 of 59 patients (11.9%) have relapsed, and 10 of 59 patients (16.9%) developed a secondary malignancy in our cohort.
Conclusion
Herein, we summarize our single-institution experience with acute promyelocytic leukemia treated over the last fifteen years. A comparison of the adverse events and efficacy of ATRA and chemotherapy versus ATRA and arsenic needs further exploration.
Session topic: E-poster
Keyword(s): Acute promyelocytic leukemia
Type: Publication Only
Background
Acute promyelocytic leukemia (APL) is a rare hematologic malignancy, with an incidence of 600-800 cases per year in the United States. At our institution, fewer than 10 patients with a new diagnosis of acute promyelocytic leukemia are treated each year.
Aims
We aim to describe our experience with patients treated for acute promyelocytic leukemia at our institution over the last 15 years.
Methods
After Mayo Clinic institutional review board approval, we searched our institutional electronic database for those 18 years and older with a new diagnosis of acute promyelocytic leukemia between January 1, 2000 and December 31, 2015. We meticulously gathered all patient information through electronic chart review.
Results
Out of a total of 89 patients reviewed, 59 patients had complete data available. The median age at diagnosis was 61 years (range: 18-80 years). 34 patients were male, and 25 were female. 9 patients (15.3%) presented with high-risk disease, 27 (45.8%) had intermediate-risk disease, and 23 (39.0%) had low-risk disease. 5 patients (8.5%) had received chemotherapy for prior malignancies. 50 patients (84.7%) received ATRA with anthracycline-based chemotherapy, and 9 received ATRA and arsenic induction. 58 of 59 (98.3%) patients achieved complete remission after induction chemotherapy. One patient died during induction due to diffuse alveolar hemorrhage. After a median follow-up of 51 months (range: 1-180 months), 53 of 59 (89.8%) patients remain alive. 2 patients died of causes related to APL, 1 of a non-APL-related cause, and 3 died of unknown causes. Among 9 patients treated with ATRA and arsenic induction, all achieved complete remission and were alive at the time of last follow-up. 28 patients (47.5%) presented with disseminated intravascular coagulation (DIC) at diagnosis. Out of 28 patients with DIC, 9 (32.1%) experienced hemorrhage, and 19 (67.9%) experienced thrombotic events. 23 of 59 patients (40.0%) developed differentiation syndrome; 3 of 9 patients (33.3%) treated with arsenic and 20 of 50 patients (40.0%) treated with chemotherapy. 6 of the 9 patients (66.7%) treated with ATRA-arsenic had grade 3 or 4 neutropenia for 15 days or more during induction therapy. 46 of 50 patients (92.0%) treated with ATRA-chemotherapy had grade 3 or 4 neutropenia during induction. Infection was documented during induction therapy in 5 of 9 patients (55.6%) treated with arsenic and 26 of 50 patients (52.0%) receiving chemotherapy. 4 of the 6 patients (66.7%) who developed hepatic toxicity were receiving arsenic. Overall, 7 of 59 patients (11.9%) have relapsed, and 10 of 59 patients (16.9%) developed a secondary malignancy in our cohort.
Conclusion
Herein, we summarize our single-institution experience with acute promyelocytic leukemia treated over the last fifteen years. A comparison of the adverse events and efficacy of ATRA and chemotherapy versus ATRA and arsenic needs further exploration.
Session topic: E-poster
Keyword(s): Acute promyelocytic leukemia
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