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

26 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Hematology

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    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, 168(5), 646-653. https://doi.org/10.1111/bjh.13189