title: Postremission therapy in acute promyelocytic leukemia: room for improvement?
abstract: A 29-year-old white man presented to the hospital with a 3-week history of fatigue, generalized weakness, gingival swelling and bleeding, and headaches. Laboratory work revealed WBC 30.4 k/μL, hemoglobin 7.9 g/dL, and platelets 16 k/μL. The WBC differential showed 64% blasts and 24% promyelocytes. Coagulation studies revealed prothrombin time (PT) 13.5 seconds, internationalized normalized ratio (INR) 1.3, fibrinogen 199 mg/dL, D-dimer greater than 1.0 μg/mL, and fibrin split products greater than 40 μg/mL. A bone-marrow aspirate with biopsy was performed, yielding the diagnosis of acute promyelocytic leukemia (APL), with t(15;17)(q23;q21.1) in all metaphases. Induction therapy commenced with daunorubicin, cytarabine (Ara-C), and all-trans retinoic acid (ATRA), and complete remission was documented 5 weeks later. PML-RARA fusion transcripts were still detected by reverse transcription polymerase chain reaction. He is now referred to you for consideration of postremission therapy in the setting of high-risk acute promyelocytic leukemia in first remission.
authors.affiliation: H. Lee Moffitt Cancer Center, Tampa, FL Jeffrey.Lancet@moffitt.org.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lancet
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000009:adverse effects*; D004562:Electrocardiography / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D010087:Oxides / Q000009:adverse effects*
chemical_list: D000970:Antineoplastic Agents; D001152:Arsenicals; D010087:Oxides; D000077237:Arsenic Trioxide