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

doi:10.1111/bjh.13189

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 journal › Article › peer-review

58 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 language	English (US)
Pages (from-to)	646-653
Number of pages	8
Journal	British Journal of Haematology
Volume	168
Issue number	5
DOIs	https://doi.org/10.1111/bjh.13189
State	Published - Mar 1 2015
Externally published	Yes

Keywords

Acute promyelocytic leukaemia
All-trans retinoic acid
Arsenic
Leukapheresis
Outcomes

ASJC Scopus subject areas

Hematology

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10.1111/bjh.13189

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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

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

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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.",

keywords = "Acute promyelocytic leukaemia, All-trans retinoic acid, Arsenic, Leukapheresis, Outcomes",

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

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doi = "10.1111/bjh.13189",

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T1 - Clinical characteristics and outcomes in patients with acute promyelocytic leukaemia and hyperleucocytosis

AU - Daver, Naval

AU - Kantarjian, Hagop

AU - Marcucci, Guido

AU - Pierce, Sherry

AU - Brandt, Mark

AU - Dinardo, Courtney

AU - Pemmaraju, Naveen

AU - Garcia-Manero, Guillermo

AU - O'Brien, Susan

AU - Ferrajoli, Alessandra

AU - Verstovsek, Srdan

AU - Popat, Uday

AU - Hosing, Chitra

AU - Anderlini, Paolo

AU - Borthakur, Gautam

AU - Kadia, Tapan

AU - Cortes, Jorge

AU - Ravandi, Farhad

PY - 2015/3/1

Y1 - 2015/3/1

N2 - 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.

AB - 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.

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

Abstract

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