Acute promyelocytic leukemia medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shyam Patel [2], Sogand Goudarzi, MD; Grammar Reviewer: Natalie Harpenau, B.S.[3]

Overview

The treatment of acute promyelocytic leukemia is broadly divided into anti-leukemia therapies and supportive therapies. Anti-leukemia therapies function to eliminate cancer cells, whereas supportive therapies are temporizing measures that can control the disease for a short time until anti-leukemic therapy takes effect. Anti-leukemic therapies include all-trans retinoic acid, arsenic trioxide, gemtuzumab ozogamicin, and cytarabine. Supportive therapies include transfusions (such as cryoprecipitate or platelet transfusions) and granulocyte colony stimulating factor.

Medical Therapy

Anti-leukemic Therapies

Supportive Therapies

  • Cryoprecipitate transfusion:
  • Packed red blood cell transfusion:
  • Platelet transfusion:
    • Platelet transfusion is indicated when the platelet count decreases to less than 10,000 cells per microliter. This low platelet count occurs especially when a patient received induction chemotherapy, such as cytarabine or anthacycline.[30]
    • Adverse effects:
      • Risks include sepsis (since platelet units are stored at room temperature where there is a high risk for contamination), volume overload, and thrombosis (less likely).[31]
  • Granulocyte colony stimulating factor (G-CSF):
    • G-CSF is sometimes uses to help improve the neutrophil count in patients with acute promyelocytic leukemia. It is important to use G-CSF only when there is no active leukemia, as G-CSF can stimulate the proliferation of leukemic blasts.[32]
    • Patients who receive G-CSF are usually those who have had a favorable anti-tumor response to chemotherapy but have not recovered their normal blood counts. G-CSF helps enhance normal blood cell count recovery.[33]
    • Adverse effects:

References

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  2. Montesinos, Pau; Sanz, Miguel A (2011). "THE DIFFERENTIATION SYNDROME IN PATIENTS WITH ACUTE PROMYELOCYTIC LEUKEMIA: EXPERIENCE OF THE PETHEMA GROUP AND REVIEW OF THE LITERATURE". Mediterranean Journal of Hematology and Infectious Diseases. 3 (1): e2011059. doi:10.4084/mjhid.2011.059. ISSN 2035-3006.
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