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Chen C, Huang X, Wang K, Chen K, Gao D, Qian S. Early mortality in acute promyelocytic leukemia: Potential predictors. Oncol Lett 2018; 15:4061-4069. [PMID: 29541170 PMCID: PMC5835847 DOI: 10.3892/ol.2018.7854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 12/08/2017] [Indexed: 01/18/2023] Open
Abstract
Acute promyelocytic leukemia (APL) is a rare leukemia characterized by the balanced reciprocal translocation between the promyelocytic leukemia gene on chromosome 15 and the retinoic acid receptor α (RARα) gene on chromosome 17, and accounts for 10-15% of newly diagnosed acute myeloid leukemia each year. The combined use of all-trans retinoic acid and arsenic trioxide (ATO) as primary therapy has markedly improved the survival rate of patients with APL. Mortality in the first 30 days following therapy remains a major contribution to treatment failure. In the present study, published data was reviewed with a focus on the factors associated with early mortality. When treated with ATO as a primary treatment, the fms-like tyrosine kinase-internal tandem deletion has no impact on early mortality. Low lymphoid enhancer binding factor-1 expression may be a reliable marker for early mortality and the target of therapy if it could be proven by further studies. Cluster of differentiation (CD)56+ and CD34+/CD2+ may be candidates to select high-risk patients. The risk of early mortality in APL still cannot be predicted via the cell surface makers, despite multiple studies on their prognostic significance. Typically, a complex translocation did not alter the survival rate in patients with APL; however, if an abnormal karyotype [e.g., Ide(17), ZBTB16/RARα and STAT5B/RARα] appeared singularly or as part of a complex mutation, there is a high possibility of early mortality if clinicians are unable to identify or monitor it.
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Affiliation(s)
- Can Chen
- Department of Hematology, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
| | - Xilian Huang
- Department of Hematology, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
| | - Kaile Wang
- Department of Hematology, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
| | - Kuang Chen
- Department of Hematology, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
| | - Danquan Gao
- Department of Hematology, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
| | - Shenxian Qian
- Department of Hematology, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, P.R. China
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Uz B, Eliaçık E, Işık A, Aksu S, Büyükaşık Y, Haznedaroğlu IC, Göker H, Sayınalp N, Ozcebe Oİ. Co-expression of t(15;17) and t(8;21) in a Case of Acute Promyelocytic Leukemia: Review of the Literature. Turk J Haematol 2014; 30:400-4. [PMID: 24385831 PMCID: PMC3874972 DOI: 10.4274/tjh.2012.0180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 01/10/2013] [Indexed: 12/01/2022] Open
Abstract
Additional chromosomal abnormalities in acute myelogenous leukemia have been identified as one of the most important prognostic factors. Favorable chromosomal changes such as t(8;21), inv(16), and t(15;17) are associated with higher rates of complete remission and event-free survival. Translocation (15;17) characterizes acute promyelocytic leukemia (APL) (French-American-British class M3) in almost all patients. Secondary chromosomal abnormalities are also present in approximately 23%-29% of patients with newly diagnosed APL. The prognostic implications of t(8;21) and other secondary cytogenetic aberrations in APL are reviewed here. We present a 47-year-old woman diagnosed with APL whose initial cytogenetic analysis included both t(8;21) and t(15;17). The initial induction chemotherapy included 3 days of idarubicin (12 mg/m2/day) and daily all-trans retinoic acid (ATRA; 45 mg/m2/day). At the sixth week of treatment, a control bone marrow biopsy was found to be normocellular, t(15;17) bcr3 and t(8;21) were negative, and t(15;17) bcr1 fusion transcripts were reduced from 5007 (1.78525699%) copies per 1 µg RNA to 40 (0.00062020%) with real-time quantitative polymerase chain reaction. Consolidation with 4 days of idarubicin (5 mg/m2/day), ATRA (45 mg/m2/day for 15 days), and cytarabine (1 g/m2/day for 4 days) was then started. However, the patient became pancytopenic and had neutropenic fever after consolidation treatment. Unfortunately, she died 3 months after the time of APL diagnosis, due to acute respiratory distress syndrome-like respiratory problems and multiorgan dysfunction requiring respiratory support and hemodialysis. Conflict of interest:None declared.
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Affiliation(s)
- Burak Uz
- Hacettepe University Medical School, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Eylem Eliaçık
- Hacettepe University Medical School, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Ayse Işık
- Hacettepe University Medical School, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Salih Aksu
- Hacettepe University Medical School, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Yahya Büyükaşık
- Hacettepe University Medical School, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Ibrahim C Haznedaroğlu
- Hacettepe University Medical School, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Hakan Göker
- Hacettepe University Medical School, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Nilgün Sayınalp
- Hacettepe University Medical School, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Osman İ Ozcebe
- Hacettepe University Medical School, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
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