Clinical characteristics and outcomes in patients with acute promyelocytic leukaemia and hyperleucocytosis

Naval Daver, Hagop Kantarjian, Guido Marcucci, Sherry Pierce, Mark Brandt, Courtney Dinardo, Naveen Pemmaraju, Guillermo Garcia-Manero, Susan O'Brien, Alessandra Ferrajoli, Srdan Verstovsek, Uday Popat, Chitra Hosing, Paolo Anderlini, Gautam Borthakur, Tapan Kadia, Jorge Cortes, Farhad Ravandi

Research output: Contribution to journalArticle

Abstract

Summary: 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 × 109/l at presentation (median WBC 85·5 × 109/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.

Original languageEnglish (US)
Pages (from-to)646-653
Number of pages8
JournalBritish Journal of Haematology
Volume168
Issue number5
DOIs
StatePublished - Mar 1 2015
Externally publishedYes

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Acute Promyelocytic Leukemia
Leukapheresis
Tretinoin
Leukocyte Count
Survival
Idarubicin
Disease-Free Survival

Keywords

  • Acute promyelocytic leukaemia
  • All-trans retinoic acid
  • Arsenic
  • Leukapheresis
  • Outcomes

ASJC Scopus subject areas

  • Hematology

Cite this

Daver, N., Kantarjian, H., Marcucci, G., Pierce, S., Brandt, M., Dinardo, C., ... Ravandi, F. (2015). Clinical characteristics and outcomes in patients with acute promyelocytic leukaemia and hyperleucocytosis. British Journal of Haematology, 168(5), 646-653. https://doi.org/10.1111/bjh.13189

Clinical characteristics and outcomes in patients with acute promyelocytic leukaemia and hyperleucocytosis. / Daver, Naval; Kantarjian, Hagop; Marcucci, Guido; Pierce, Sherry; Brandt, Mark; Dinardo, Courtney; Pemmaraju, Naveen; Garcia-Manero, Guillermo; O'Brien, Susan; Ferrajoli, Alessandra; Verstovsek, Srdan; Popat, Uday; Hosing, Chitra; Anderlini, Paolo; Borthakur, Gautam; Kadia, Tapan; Cortes, Jorge; Ravandi, Farhad.

In: British Journal of Haematology, Vol. 168, No. 5, 01.03.2015, p. 646-653.

Research output: Contribution to journalArticle

Daver, N, Kantarjian, H, Marcucci, G, Pierce, S, Brandt, M, Dinardo, C, Pemmaraju, N, Garcia-Manero, G, O'Brien, S, Ferrajoli, A, Verstovsek, S, Popat, U, Hosing, C, Anderlini, P, Borthakur, G, Kadia, T, Cortes, J & Ravandi, F 2015, 'Clinical characteristics and outcomes in patients with acute promyelocytic leukaemia and hyperleucocytosis', British Journal of Haematology, vol. 168, no. 5, pp. 646-653. https://doi.org/10.1111/bjh.13189
Daver, Naval ; Kantarjian, Hagop ; Marcucci, Guido ; Pierce, Sherry ; Brandt, Mark ; Dinardo, Courtney ; Pemmaraju, Naveen ; Garcia-Manero, Guillermo ; O'Brien, Susan ; Ferrajoli, Alessandra ; Verstovsek, Srdan ; Popat, Uday ; Hosing, Chitra ; Anderlini, Paolo ; Borthakur, Gautam ; Kadia, Tapan ; Cortes, Jorge ; Ravandi, Farhad. / Clinical characteristics and outcomes in patients with acute promyelocytic leukaemia and hyperleucocytosis. In: British Journal of Haematology. 2015 ; Vol. 168, No. 5. pp. 646-653.
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