title: Clinical characteristics and outcomes in patients with acute promyelocytic leukaemia and hyperleucocytosis.
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 × 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.
authors.affiliation: Departments of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
authors.forename: Naval
authors.initials: N
authors.lastname: Daver
authors.forename: Hagop
authors.initials: H
authors.lastname: Kantarjian
authors.forename: Guido
authors.initials: G
authors.lastname: Marcucci
authors.forename: Sherry
authors.initials: S
authors.lastname: Pierce
authors.forename: Mark
authors.initials: M
authors.lastname: Brandt
authors.forename: Courtney
authors.initials: C
authors.lastname: Dinardo
authors.forename: Naveen
authors.initials: N
authors.lastname: Pemmaraju
authors.forename: Guillermo
authors.initials: G
authors.lastname: Garcia-Manero
authors.forename: Susan
authors.initials: S
authors.lastname: O'Brien
authors.forename: Alessandra
authors.initials: A
authors.lastname: Ferrajoli
authors.forename: Srdan
authors.initials: S
authors.lastname: Verstovsek
authors.forename: Uday
authors.initials: U
authors.lastname: Popat
authors.forename: Chitra
authors.initials: C
authors.lastname: Hosing
authors.forename: Paolo
authors.initials: P
authors.lastname: Anderlini
authors.forename: Gautam
authors.initials: G
authors.lastname: Borthakur
authors.forename: Tapan
authors.initials: T
authors.lastname: Kadia
authors.forename: Jorge
authors.initials: J
authors.lastname: Cortes
authors.forename: Farhad
authors.initials: F
authors.lastname: Ravandi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007937:Leukapheresis; D015473:Leukemia, Promyelocytic, Acute / Q000097:blood / Q000401:mortality / Q000628:therapy; D007958:Leukocyte Count; D007964:Leukocytosis / Q000097:blood / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010087:Oxides / Q000008:administration & dosage; D012189:Retrospective Studies; D015996:Survival Rate; D014212:Tretinoin / Q000008:administration & dosage
chemical_list: D001152:Arsenicals; D010087:Oxides; D014212:Tretinoin; D000077237:Arsenic Trioxide
keywords: acute promyelocytic leukaemia; all-trans retinoic acid; arsenic; leukapheresis; outcomes