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Cui H, Ma Y, Han S, Zhang X, Fu W, Yang S, Liu T, Zhang X. Arsenic trioxide regulates the glycolytic pathway to treat acute promyelocytic leukemia by inhibiting RPL22L1. Leuk Res 2024; 144:107550. [PMID: 39079325 DOI: 10.1016/j.leukres.2024.107550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/16/2024] [Accepted: 07/23/2024] [Indexed: 09/03/2024]
Abstract
OBJECTIVE To investigate the relationship between the treatment of acute promyelocytic leukemia (APL) with arsenic trioxide (ATO) and glycolysis, as well as its underlying molecular mechanism. METHODS The GEO database was used to analyze alterations in the expression of RPL22L1 in APL patients and its correlation with glycolysis. The levels of RPL22L1 and glycolysis were assessed in 9 paired clinical samples. NB4 cells and NB4 cells with knockdown of RPL22L1 were treated with ATO. The protein and mRNA of RPL22L1 were detected using RT-PCR and Western blot, and the content was determined by using glucose, pyruvate, and lactate detection kits. Finally, detection of cell proliferation using CCK8, migration by scratch assay, and apoptosis by flow cytometry, and the biological function of ATO in NB4 cells was examined. RESULTS The expression of RPL22L1 in GSE213742 and GSE234103 datasets exhibited a significant increase in human APL cells, specifically NB4 cells. RPL22L1 in GSE213742 and GSE234103 gene expression matrix was significantly elevated in human APL cells NB4 cells, and further analysis found RPL22L1 showed a strong positive correlation with glycolysis. Cellular experiments showed that ATO inhibited RPL22L1 in NB4 cells and inhibited glycolysis in APL cells. The ATO played a pivotal role in suppressing the proliferation, migration, as well as invasion of NH4 cells. CONCLUSION ATO regulates the blycolytic pathway in APL by inhibiting RPL22L1 expression, and this may contribute to its therapeutic effects.
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Affiliation(s)
- Heran Cui
- Department of Hematology, the Second Affiliated Hospital of Qiqihar Medical University, China
| | - Yuanyang Ma
- Department of Laboratory Medicine, The Second Affiliated Hospital of Qiqihar Medical University, China
| | - Shulin Han
- Department of Hematology, the Second Affiliated Hospital of Qiqihar Medical University, China
| | - Xiaodong Zhang
- Department of Hematology, the Second Affiliated Hospital of Qiqihar Medical University, China
| | - Weiya Fu
- Department of Hematology, the Second Affiliated Hospital of Qiqihar Medical University, China
| | - Shuang Yang
- Department of Hematology, the Second Affiliated Hospital of Qiqihar Medical University, China
| | - Tianhang Liu
- Department of Hematology, the Second Affiliated Hospital of Qiqihar Medical University, China
| | - Xuefang Zhang
- Department of Hematology, the Second Affiliated Hospital of Qiqihar Medical University, China.
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Li H, Zhang Y, Fan S, Li D, Zhang Q, Fu J, Lu D, Ji J, Li Y. Analysis of early death in critically ill patients with acute promyelocytic leukaemia in the HICU. Sci Rep 2024; 14:19987. [PMID: 39198685 PMCID: PMC11358486 DOI: 10.1038/s41598-024-71082-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 08/23/2024] [Indexed: 09/01/2024] Open
Abstract
This study was conducted to identify the characteristics and risk factors for early death in critically ill acute promyelocytic leukaemia (APL) patients in the Hemato-oncology ICU (HICU). A total of 44 APL patients from 2017 to 2023 were included. The mortality among APL patients in the HICU was high (27/44, 61.36%). Compared with patients who survived, nonsurvivors had a longer prothrombin time (P = 0.002), lower fibrinogen (P = 0.022), higher white blood cell count (P = 0.004) and higher creatinine (P = 0.037) on hosipital admission. Severe bleeding was the most frequent complication (34 cases, 77.27%), which occurred either preinduction or on Day 5 (IQR 3-7.5 days) of induction. Cerebral bleeding associated with consciousness disturbance was the main reason for HICU admission (18 cases, 40.9%). The leading cause of death was fatal haemorrhage (18/34, 52.94%), which occurred either preinduction or on Day 4 (IQR 3-7 days) of induction. Another common cause of death was sepsis (8/18, 44.44%), which occurred on Day 12 (IQR 9.5-24.75 days) during induction. In conclusion, the main cause of death in APL patients treated in the HICU was primary being attributed to fatal bleeding, followed by sepsis.
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Affiliation(s)
- Haitao Li
- Harbin Medical University, No. 157 Health Road, Nangang District, Harbin, 150001, China
| | - Yingmei Zhang
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Shengjin Fan
- Department of Hematology, First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Dandan Li
- Department of Hematology, First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Qian Zhang
- Department of Hematology, First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Jinyue Fu
- Department of Hematology, First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Dongxue Lu
- Department of Hematology, First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Jiajuan Ji
- Department of Hematology, First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Yinghua Li
- Harbin Medical University, No. 157 Health Road, Nangang District, Harbin, 150001, China.
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Yokoyama Y. Risk factors and remaining challenges in the treatment of acute promyelocytic leukemia. Int J Hematol 2024:10.1007/s12185-023-03696-7. [PMID: 38386203 DOI: 10.1007/s12185-023-03696-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/19/2023] [Accepted: 12/25/2023] [Indexed: 02/23/2024]
Abstract
The treatment of acute promyelocytic leukemia (APL) has evolved with the introduction of all-trans retinoic acid (ATRA) and subsequent arsenic trioxide (ATO), particularly in standard-risk APL with an initial white blood cell count (WBC) < 10,000/μL, where a high cure rate can now be achieved. However, for some patients with risk factors, early death or relapse remains a concern. Insights from the analysis of patients treated with ATRA and chemotherapy have identified risk factors such as WBC, surface antigens, complex karyotypes, FLT3 and other genetic mutations, p73 isoforms, variant rearrangements, and drug resistance mutations. However, in the ATRA + ATO era, the significance of these risk factors is changing. This article provides a comprehensive review of APL risk factors, taking into account the treatment approach, and explores the challenges associated with APL treatments.
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Affiliation(s)
- Yasuhisa Yokoyama
- Department of Hematology, University of Tsukuba, Tsukuba, Ibaraki, Japan.
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Liao H, Xu Y, Meng Q, Mao Z, Qiao Y, Liu Y, Zheng Q. A convolutional neural network-based, quantitative complete blood count scattergram-mapping framework promptly screens acute promyelocytic leukemia with high sensitivity. Cancer 2023; 129:2986-2998. [PMID: 37254628 DOI: 10.1002/cncr.34890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML) characterized by its rapidly progressive and fatal clinical course if untreated, although it is curable if treated in a timely manner. Promptly screening patients who have results that are suspicious for APL is vital to overcome early death. METHODS The authors developed an innovative framework consisting of ResNet-18, a convolutional neural network architecture, with the objective of quantitatively mapping a complete blood count (CBC) scattergram to quickly and robustly indicate a probable susceptibility to APL. Three hundred and twenty scattergrams of the white blood cell differential channel from 51 patients with APL, 510 scattergrams from 105 patients who had non-APL AML, and 320 scattergrams from 320 healthy controls were randomly stratified at a ratio of 4:1 and split into training and testing data sets to accomplish five-fold cross-validation. RESULTS Both the area under the curve and the average precision of >0.99 were achieved in each fold. Three hundred four of the 320 APL scattergrams (95%) were correctly flagged by the model, which outcompeted the CBC review rules recommended by the International Society of Laboratory Hematology (all p < .001). External validation based on an independent testing data set that included 56 scattergrams from 31 patients with APL, 56 scattergrams from 55 patients with non-APL AML, and 64 scattergrams from 64 healthy controls also confirmed the sensitivity and specificity of the framework. CONCLUSIONS To the authors' knowledge, their convolutional neural network-based framework is the first to use scattergram output from routine CBC analysis to map suspicious APL early with outstanding sensitivity, specificity, and precision. The authors also describe a new CBC workflow incorporating this framework upstream of the morphologic review, which would provide the earliest flag for APL. PLAIN LANGUAGE SUMMARY The authors propose an innovative way to visualize complete blood counts (CBCs) by mapping the difference in white blood cell counts using automated CBC analysis to identify potential acute promyelocytic leukemia (APL) using a convolutional neural network (CNN), which can eliminate the potential pitfalls of manual observation. Analyses of an unprecedented, realistic data set validated that the quantitative relationship between the CBC scattergram and an APL abnormality is highly consistent. This is the first study to date focusing on screening for APL using scattergrams of the difference in white blood cell counts from routine CBC tests and has significant clinical relevance. The authors recommend using this method even before analyzing cell images, which could provide the earliest way to screen for APL in a sensitive and accurate way.
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Affiliation(s)
- Hongyan Liao
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanxin Xu
- College of Electrical Engineering, Sichuan University, Chengdu, China
| | - Qiang Meng
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zhigang Mao
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yifan Qiao
- College of Computer Science, Sichuan University, Chengdu, China
| | - Yan Liu
- College of Electrical Engineering, Sichuan University, Chengdu, China
| | - Qin Zheng
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
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Zhao S, Ge Y, Li Z, Yang T. Influence of cytokines on early death and coagulopathy in newly diagnosed patients with acute promyelocytic leukemia. Front Immunol 2023; 14:1100151. [PMID: 37063881 PMCID: PMC10103902 DOI: 10.3389/fimmu.2023.1100151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/06/2023] [Indexed: 04/03/2023] Open
Abstract
IntroductionAcute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML) with a better prognosis. But early death (ED) rate remains high. APL patients are simultaneously accompanied by coagulopathy and hyperinflammation at the onset. It is not known what effects cytokines have on ED and coagulopathy in these patients. Therefore, the purposes of this study are to explore the clinical differences between APL and other types of AML, the link between cytokines and coagulopathy in newly diagnosed APL, and their roles in the ED for APL.MethodsThis study retrospectively collected the information of 496 adult patients with AML (age ≥14 years at admission) newly diagnosed in the First People's Hospital of Yunnan Province between January 2017 to February 2022, including 115 APL patients. The difference of clinical manifestations between two groups [APL and AML (non-APL)] was statistically analyzed. Then, the factors affecting ED in APL patients were screened, and the possible pathways of their influence on ED were further analyzed.ResultsThe results indicate APL at the onset have a younger age and higher incidence of ED and DIC than other types of AML. Intracranial hemorrhage (ICH), age, and PLT count are found to be independent factors for ED in newly APL, among which ICH is the main cause of ED, accounting for 61.54% (8/13). The levels of cytokines in newly APL are generally higher than that in AML (non-APL), and those in the group of ED for APL were widely more than the control group. IL-17A and TNF-β are directly related to the ED in newly APL, especially IL-17A, which also affects ICH in these patients. Moreover, the increase of IL-17A and TNF-β cause the prolongation of PT in APL patients, which reflected the exogenous coagulation pathway. However, they have no effect on APTT prolongation and FIB reduction. Thus, it is speculated that IL-17A leads to early cerebral hemorrhage death in newly APL by inducing tissue factor (TF) overexpression to initiate exogenous coagulation and further leading to excessive depletion of clotting factors and prolongation of PT.ConclusionsIn conclusion, compared with other types of AML, APL patients have a younger age of onset and high inflammatory state, and are more likely to develop into DIC and die early. Age, and PLT count at diagnosis are independent factors for ED of APL, especially ICH. IL-17A is confirmed to be an independent risk factor for ED and ICH of newly APL. Hence, IL-17A may serve as a predictor of ED in newly diagnosed APL patients, and controlling its expression probably reduce ED in these patients.
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Affiliation(s)
- Shixiang Zhao
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
- Department of Hematology, The First People’s Hospital of Yunnan Province, Kunming, China
- Yunnan Blood Disease Clinical Medical Center, The First People’s Hospital of Yunnan Province, Kunming, China
- Yunnan Blood Disease Hospital, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Yuanyuan Ge
- Department of Cardiology, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Zengzheng Li
- Department of Hematology, The First People’s Hospital of Yunnan Province, Kunming, China
- Yunnan Blood Disease Clinical Medical Center, The First People’s Hospital of Yunnan Province, Kunming, China
- Yunnan Blood Disease Hospital, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Tonghua Yang
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
- Department of Hematology, The First People’s Hospital of Yunnan Province, Kunming, China
- Yunnan Blood Disease Clinical Medical Center, The First People’s Hospital of Yunnan Province, Kunming, China
- Yunnan Blood Disease Hospital, The First People’s Hospital of Yunnan Province, Kunming, China
- *Correspondence: Tonghua Yang,
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Li G, Wu J, Li R, Pan Y, Ma W, Xu J, Nan M, Hou L. Improvement of Early Death in Acute Promyelocytic Leukemia: A Population-Based Analysis. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e78-e84. [PMID: 36567214 DOI: 10.1016/j.clml.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/14/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Early death is a major factor of treatment failure in acute promyelocytic leukemia (APL), however, the recent trends in the incidence of early death based on the population-level are not clear. Hence, this study is aimed at describing the incidence, recent trends, causes and characteristics of early death in APL based on the real world. MATERIALS AND METHODS APL patients diagnosed from 1986 to 2015 in the Surveillance, Epidemiology, and End Results (SEER) dataset were enrolled, and categorized based on gender, age, year of diagnosis, race, marital status, resident county and socioeconomic status (SES). The risk factors for all-cause and acute myelocytic leukemia (AML) specific early death were determined by univariate and multivariate logistic regression analyses, and stratified analysis was conducted by age. RESULTS Overall, 3212 APL patients were included in analysis between 1986 and 2015, of which a total of 683 (21.3%) patients were noted for early death. Significant differences were recognized for patient distribution by age, year of diagnosis, marital status, and SES. The early death rate of APL patients diagnosed during 2006-2015 was significantly lower than that of the early stage, but this trend was not evident in juvenile patients. At the same time, older age, and lower SES score were independent risk factors for early death in the multivariate analysis. CONCLUSION We established that the early death trend in APL has decreased over the past few years, but the early death rate remains high, especially in older patients and those with lower SES.
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Affiliation(s)
- Guangda Li
- Department of Hematology and Oncology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China; Beijing University of Chinese Medicine, Beijing, China
| | - Jieya Wu
- Department of Hematology and Oncology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China; Beijing University of Chinese Medicine, Beijing, China
| | - Ruibai Li
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medicine Sciences, Beijing, China
| | - Yiming Pan
- Department of Hematology and Oncology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China; Beijing University of Chinese Medicine, Beijing, China
| | - Wei Ma
- Department of Hematology and Oncology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jing Xu
- Department of Hematology and Oncology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China; Beijing University of Chinese Medicine, Beijing, China
| | - Mengdie Nan
- Department of Hematology and Oncology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China; Beijing University of Chinese Medicine, Beijing, China
| | - Li Hou
- Department of Hematology and Oncology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
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Ortaboz D, Çetin MS, Cömert B, Eşkazan AE. ATRA+ATO combination in APL - A commentary on "evolving of treatment paradigms and challenges in acute promyelocytic leukaemia: A real-world analysis of 1105 patients over the last three decades" by Teng-Fei et al. Transl Oncol 2023; 29:101620. [PMID: 36737174 PMCID: PMC9937804 DOI: 10.1016/j.tranon.2023.101620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Affiliation(s)
- Damla Ortaboz
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Mehmed Semih Çetin
- Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Burak Cömert
- Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
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Wen J, Xu F, Zhou Q, Shi L, Liu Y, Yue J, Zhang Y, Liang X. Effects of peripheral blood leukocyte count and tumor necrosis factor-alpha on early death in acute promyelocytic leukemia. BMC Cancer 2023; 23:27. [PMID: 36611025 PMCID: PMC9824944 DOI: 10.1186/s12885-022-10499-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Early death remains a major factor in survival in APL. We aimed to analyze the risk factors for differentiation syndrome and early death in acute promyelocytic leukemia (APL). METHODS The clinical data of APL patients who were newly diagnosed at Mianyang Central Hospital from January 2013 to January 2022 were retrospectively analyzed. RESULTS Eighty-six newly diagnosed APL patients (37 males and 49 females) were included in this study. The median age was 46 (17-75) years. Sixty-one patients (70.9%) had low/intermediate-risk APL, and 25 patients (29.1%) had high-risk APL. The incidence of differentiation syndrome (DS) was 62.4%. The multivariate analysis showed that a peak white blood cell (WBC) count ≥16 × 10^9/L was an independent risk factor (OR = 11.000, 95% CI: 2.830-42.756, P = 0.001) for DS in all APL patients, while a WBC count ≥10 × 10^9/L on Day 5 was an independent risk factor for DS in low-intermediate risk APL patients (OR = 9.114, 95% CI: 2.384-34.849, P = 0.001). There were 31 patients (36.5%) with mild DS and 22 patients (25.9%) with severe DS. The multivariate analysis showed that WBC count ≥23 × 10^9/L at chemotherapy was an independent risk factor for severe DS (OR = 10.500, 95% CI: 2.344-47.034, P = 0.002). The rate of early death (ED) was 24.4% (21/86). The multivariate analysis showed that male gender (OR = 7.578,95% CI:1.136-50.551, P = 0.036), HGB < 65 g/L (OR = 16.271,95% CI:2.012-131.594, P = 0.009) and WBC count ≥7 × 10^9/L on Day 3(OR = 23.359,95% CI:1.825-298.959, P = 0.015) were independent risk factors for ED. The WBC count at diagnosis, WBC count on Day 3 and WBC count on Day 5 had moderate positive correlations with tumor necrosis factor-α (TNF-α) at diagnosis, and the correlation coefficients were 0.648 (P = 0.012), 0.615 (P = 0.033), and 0.609 (P = 0.035), respectively. The WBC count had no correlation with IL-6. CONCLUSION During induction treatment, cytotoxic chemotherapy may need to be initiated to reduce the risk of DS for APL patients with a low-intermediate risk WBC count ≥10 × 10^9/L on Day 5 or for all patients with a peak WBC count ≥16 × 10^9/L. Patients with WBC > 7 × 10^9/L on Day 3 have a higher risk of ED. Leukocyte proliferation is associated with TNF-α rather than IL-6, and TNF-α may be a potential biomarker for predicting ED.
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Affiliation(s)
- Jingjing Wen
- grid.54549.390000 0004 0369 4060Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No 12. Changjia alley, Jingzhong Street, Fucheng district, Mianyang, 621000 China
| | - Fang Xu
- grid.54549.390000 0004 0369 4060Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No 12. Changjia alley, Jingzhong Street, Fucheng district, Mianyang, 621000 China
| | - Qiaolin Zhou
- grid.54549.390000 0004 0369 4060Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No 12. Changjia alley, Jingzhong Street, Fucheng district, Mianyang, 621000 China
| | - Lin Shi
- grid.54549.390000 0004 0369 4060Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No 12. Changjia alley, Jingzhong Street, Fucheng district, Mianyang, 621000 China
| | - Yiping Liu
- grid.54549.390000 0004 0369 4060Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No 12. Changjia alley, Jingzhong Street, Fucheng district, Mianyang, 621000 China
| | - Jing Yue
- grid.54549.390000 0004 0369 4060Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No 12. Changjia alley, Jingzhong Street, Fucheng district, Mianyang, 621000 China
| | - Ya Zhang
- grid.54549.390000 0004 0369 4060Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No 12. Changjia alley, Jingzhong Street, Fucheng district, Mianyang, 621000 China
| | - Xiaogong Liang
- grid.54549.390000 0004 0369 4060Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No 12. Changjia alley, Jingzhong Street, Fucheng district, Mianyang, 621000 China
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The characteristics and long-term outcomes of acute promyelocytic leukemia patients with early intracranial hemorrhage. Int J Hematol 2022; 117:538-543. [PMID: 36522588 DOI: 10.1007/s12185-022-03515-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
Intracranial hemorrhage (ICH) is a major cause of early death (ED) and leads to poor prognosis in acute promyelocytic leukemia (APL). We retrospectively described 27 unselected APL patients who experienced early ICH. The ED rate was 37%. The 3-year overall survival (OS) rate was 45.4%, while the 3-year OS rate of patients who survived through induction therapy was 87.5%. No patient experienced central nervous system leukemia (CNSL). Concurrent differentiation syndrome, white blood cell count, prothrombin time and D-dimer were related to death. Although the ED rate among APL patients with early ICH was high, patients with early ICH had a favorable outcome after surviving through induction therapy. CNSL was rare despite a history of ICH during induction therapy. Compared with APL patients without ICH, it seems unnecessary to administer additional measures to prevent CNSL for this subpopulation in the era of all-trans retinoic acid and arsenic trioxide, but this needs further validation in prospective trials.
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Evolving of treatment paradigms and challenges in acute promyelocytic leukaemia: A real-world analysis of 1105 patients over the last three decades. Transl Oncol 2022; 25:101522. [PMID: 36075113 PMCID: PMC9465437 DOI: 10.1016/j.tranon.2022.101522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/06/2022] [Accepted: 08/12/2022] [Indexed: 11/22/2022] Open
Abstract
Although acute promyelocytic leukaemia (APL) is a highly curable disease, challenges of early death (ED) and relapse still exist, and real-world data are scarce in the ATRA plus ATO era. A total of 1105 APL patients from 1990 to 2020 were enrolled and categorized into three treatment periods, namely ATRA, ATRA plus ATO, and risk-adapted therapy. The early death (ED) rate was 20.2%, 10.1%, and 7.0%, respectively, in three periods, while there was no significant decline in the 7-day death rate. Consistently, the overall survival (OS) and disease-free survival (DFS) of APL patients markedly improved over time. Despite the last two periods exhibiting similar DFS, the chemotherapy load was substantially lower in Period 3. Notably, leveraging older age and higher WBC count (especially > 50 × 109/L), we could identify a small group of extremely high-risk patients who had a very high ED rate and poor prognosis, while those with NRAS mutations and higher WBC tended to relapse, both representing obstacles to curing all patients. In conclusion, the evolvement of treatment paradigms can reduce the ED rate, improve clinical outcomes, and spare patients the toxicity of chemotherapy. Special care and innovative agents are warranted for the particularly high-risk APL.
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