Prompt Initiation of Conventional Chemotherapy to Avoid Early Death in Patients with Newly Diagnosed Acute Promyelocytic Leukemia

• Published in: Internal Medicine Vol. 62; no. 15; pp. 2181 - 2185
• Main Authors: Matsuda, Kensuke, Oyama, Takashi, Maki, Hiroaki, Nakazaki, Kumi, Yasunaga, Megumi, Honda, Akira, Masamoto, Yosuke, Kurokawa, Mineo
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01.08.2023; Japan Science and Technology Agency
• Subjects: acute promyelocytic leukemia; Acute promyeloid leukemia; all-trans retinoic acid; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Chemotherapy; Clinical trials; Death; early death; Humans; Induction therapy; Internal medicine; Leukemia; Leukemia, Promyelocytic, Acute - diagnosis; Leukemia, Promyelocytic, Acute - drug therapy; Original; Patients; Promyeloid leukemia; Prospective Studies; Remission; Remission Induction; Retinoic acid; Treatment Outcome; Tretinoin - therapeutic use; all-trans retinoic acid; acute promyelocytic leukemia; early death; chemotherapy
• ISSN: 0918-2918; 1349-7235; 1349-7235
• DOI: 10.2169/internalmedicine.0937-22

Objective Compared to prospective trials, the early death rate of newly diagnosed acute promyelocytic leukemia (APL) in the real-world clinical setting is higher. However, the early death rate was heterogeneous according to the reported institutes. Thus, the therapeutic approach at each institute may be important for preventing early death. This study evaluated the management strategy for untreated APL in our institute to avoid early death. Methods We identified consecutive 21 patients with untreated APL who received induction therapy including all-trans retinoic acid (ATRA) between July 2007 and December 2021 at the University of Tokyo Hospital. Results As therapeutic approaches, 16 patients (76%) received ATRA administration on the day of admission, and the remaining 5 received ATRA within 4 days from admission. Notably, all patients received conventional chemotherapy added to ATRA at a median of 1 day from admission (range: 0-9 days). As clinical outcomes, no patient died during induction therapy for untreated APL, and all achieved complete molecular remission. Conclusion Compared to the previous nationwide survey, a higher proportion of patients at our institute received conventional chemotherapy in addition to ATRA, and it was initiated more promptly, which may have helped prevent early death.