title: Acute promyelocytic leukemia: impact of hemorrhagic complications on response to induction chemotherapy and survival.
abstract: From 1976 to 1989, 21 adult patients with previously untreated acute promyelocytic leukemia were seen at the University of Virginia Hospital. We reviewed their cases retrospectively to determine the impact of hemorrhagic complications and other factors on treatment outcome. We observed a complete remission rate of 35%; the median survival in complete responders was 15 months. Evidence of disseminated intravascular coagulation was found in 13 (62%) of the 21 cases at diagnosis. Fatal intracranial hemorrhage was the leading cause of death, occurring in eight (40%) of the 20 patients evaluated. Initial leukocyte count greater than 4.0 x 10(9)/L and platelet count less than 20 x 10(9)/L were significantly associated with an increased risk of intracranial hemorrhage. In patients with disseminated intravascular coagulation, the rate of intracranial hemorrhage was reduced by treatment with heparin. The high mortality of 40% (8/20) due to intracranial hemorrhage during induction was a major contributor to the low complete remission rate of 35% (7/20) in this series of consecutive unselected patients with newly diagnosed acute promyelocytic leukemia.
authors.affiliation: Department of Internal Medicine, University of Virginia Health Sciences Center, Charlottesville 22908.
authors.forename: J E
authors.initials: JE
authors.lastname: Humphries
authors.forename: C E
authors.initials: CE
authors.lastname: Hess
authors.forename: F M
authors.initials: FM
authors.lastname: Stewart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001772:Blood Cell Count; D002423:Cause of Death; D002543:Cerebral Hemorrhage / Q000097:blood / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D005069:Evaluation Studies as Topic; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D006493:Heparin; D001241:Aspirin