Does leukocytosis remain a predictive factor for survival outcomes in patients with acute promyelocytic leukemia receiving ATRA plus a chemotherapy-based regimen? A prospective multicenter analysis from TALWG
Issued Date
2023-01-01
Resource Type
ISSN
10245332
eISSN
16078454
Scopus ID
2-s2.0-85150789915
Pubmed ID
36951362
Journal Title
Hematology (United Kingdom)
Volume
28
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
Hematology (United Kingdom) Vol.28 No.1 (2023)
Suggested Citation
Kungwankiattichai S., Owattanapanich W., Rattanathammethee T., Rattarittamrong E., Chanswangphuwana C., Polprasert C., Limvorapitak W., Saengboon S., Niparuck P., Puavilai T., Julamanee J., Saelue P., Wanitpongpun C., Prayongratana K., Sriswasdi C., Nakhakes C. Does leukocytosis remain a predictive factor for survival outcomes in patients with acute promyelocytic leukemia receiving ATRA plus a chemotherapy-based regimen? A prospective multicenter analysis from TALWG. Hematology (United Kingdom) Vol.28 No.1 (2023). doi:10.1080/16078454.2023.2191462 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/82548
Title
Does leukocytosis remain a predictive factor for survival outcomes in patients with acute promyelocytic leukemia receiving ATRA plus a chemotherapy-based regimen? A prospective multicenter analysis from TALWG
Author's Affiliation
Ramathibodi Hospital
Siriraj Hospital
Faculty of Medicine, Chiang Mai University
Faculty of Medicine, Khon Kaen University
Faculty of Medicine, Prince of Songkia University
Faculty of Medicine, Thammasat University
Phramongkutklao College of Medicine
Rajavithi Hospital
Faculty of Medicine, Chulalongkorn University
Siriraj Hospital
Faculty of Medicine, Chiang Mai University
Faculty of Medicine, Khon Kaen University
Faculty of Medicine, Prince of Songkia University
Faculty of Medicine, Thammasat University
Phramongkutklao College of Medicine
Rajavithi Hospital
Faculty of Medicine, Chulalongkorn University
Other Contributor(s)
Abstract
Introduction: Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia (AML) with a unique clinical presentation and prognosis. This study aimed to investigate the epidemiology, clinical characteristics, treatments, and clinical outcomes of Thai APL patients dominantly treated with all-trans-retinoic acid (ATRA) combined with a chemotherapy-based therapy. Methods: This was an eight-year prospective, observational study from nine academic hospitals in the Thai Acute Leukemia Working Group (TALWG) of the Thai Society of Hematology, which included newly diagnosed Thai APL patients, aged 18 years or older. The web-based registration collected baseline charateristic, and clinical outcomes. Results: From 992 newly diagnosed AML patients, 79 APL patients were enrolled in this study. Almost all subjects were de novo APL (94.9%), while the others were therapy-related APL. The commonest clinical presentation was disseminated intravascular coagulation (38%). One-third of the patients were categorized as high risk according to the initial WBC. Almost all patients received ATRA combined with idarubicin regimen. The complete response rate was as high as 95.7%, which translated into excellent four-year overall survival (OS) (75.6%) and four-year leukemia-free survival (LFS) (75.4%). The multivariate analysis demonstrated that the older age and WBC count >20 × 109/L conferred a significantly unfavorable OS with the hazard ratios of 3.03 (95% confidence interval [CI]: 1.14–8.05) and 4.18 (95%CI: 1.69–10.35), respectively. Similarly, these two parameters remained independent of the poor prognosis factors for LFS. Conclusion: This report confirmed that APL had a favorable prognosis. However, advanced age and high WBC count >20 × 109/L contributed to a worse outcome. Abbreviations: APL; acute promyelocytic leukemia; ATRA; all-transretinoic acid; CR; complete remission; DS; differentiation syndrome; ECOG; Eastern Cooperative Oncology Group; ED; early death; HR; hazard ratio; IQR; interquartile range; LFS; leukemia-free survival; OS; overall survival; WBC; white blood cell.