Acute promyelocytic leukemia natural history, complications and prognosis

Jump to: navigation, search

Acute promyelocytic leukemia Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Acute promyelocytic leukemia from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Other Imaging Studies

Other Diagnostic Studies

Treatment

Medical Therapy

Interventions

Surgery

Primary PreventionSurgery

Secondary PreventionSurgery

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Acute promyelocytic leukemia natural history, complications and prognosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Acute promyelocytic leukemia natural history, complications and prognosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Acute promyelocytic leukemia natural history, complications and prognosis

CDC on Acute promyelocytic leukemia natural history, complications and prognosis

Acute promyelocytic leukemia natural history, complications and prognosis in the news

Blogs on Acute promyelocytic leukemia natural history, complications and prognosis

Directions to Hospitals Treating Acute promyelocytic leukemia

Risk calculators and risk factors for Acute promyelocytic leukemia natural history, complications and prognosis

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

Overview

The natural history of acute promyelocytic leukemia is characterized by symptoms related to defective normal blood cell production. These symptoms include fatigue, bleeding, and infection. Complications include thrombosis and hemorrhage, which eventually occur in a significant proportion of patients. Early death is common and is related to bleeding complications. Therapy-related complications include differentiation syndrome, QT interval prolongation, and cardiomyopathy. The prognosis of acute promyelocytic leukemia was previously poor, but the advent of arsenic trioxide and all-trans retinoic acid has rendered the prognosis to be far more favorable in the recent years.

Natural History

Complications

In a 2015 study from MD Anderson Cancer Center, it was shown that the annual incidence of venous thromboembolism, which includes deep vein thrombosis and pulmonary embolism, was 6.1-42%, which is the highest amongst all leukemia sub-types. In contrast, the incidence of venous thromboembolism in chronic myeloid leukemia was only 1.5%.[7]

Disease Thrombotic Incidence

Acute promyelocytic leukemia

6.1-48%

Acute myeloid leukemia

3.7%

Chronic lymphocytic leukemia

2.7%

Acute lymphoblastic leukemia

2.1-13%

Chronic myeloid leukemia

1.5%

Prognosis

  • Prior to the introduction of readily available diagnostics and targeted therapeutics, the prognosis of acute promyelocytic leukemia was previously very poor, especially in the early phase of the disease.[31][32]
  • The poor prognosis was due to high bleeding risk and death from hemorrhagic complications due to disseminated intravascular coagulation. Death typically occurs within a few days to weeks in the absence of treatment. The early death rate is estimated to be 17.3%, based on a large population-based analysis that was conducted in the United Stated between 1992-2007.[33] [2]
  • The 5-year survival rate is only 30-40% after 5 years in younger patients.[23] In the current era of medicine (after the introduction of all-trans retinoic acid and arsenic trioxide), the prognosis of acute promyelocytic leukemia carries a much better prognosis.[3]
  • Patients can achieve long-term, durable remission if treated appropriately in an expedited manner with medications such as all-''trans'' retinoic acid, arsenic trioxide, or cytotoxic chemotherapy. The current overall survival rate is 86-97%, and the complete remission rate is 90-100%.[23]
  • In a multi-center study published in 2017 that evaluated the long-term outcomes of patients with acute promyelocytic leukemia, the complete remission rate was 96% [34] and induction mortality if low at 4%.[34]

References

  1. Franchini M, Lippi G, Manzato F (2006). "Recent acquisitions in the pathophysiology, diagnosis and treatment of disseminated intravascular coagulation". Thromb J. 4: 4. doi:10.1186/1477-9560-4-4. PMC 1402263. PMID 16504043.
  2. 2.0 2.1 Chen C, Huang X, Wang K, Chen K, Gao D, Qian S (2018). "Early mortality in acute promyelocytic leukemia: Potential predictors". Oncol Lett. 15 (4): 4061–4069. doi:10.3892/ol.2018.7854. PMC 5835847. PMID 29541170.
  3. 3.0 3.1 3.2 Coombs CC, Tavakkoli M, Tallman MS (2015). "Acute promyelocytic leukemia: where did we start, where are we now, and the future". Blood Cancer J. 5: e304. doi:10.1038/bcj.2015.25. PMC 4450325. PMID 25885425.
  4. 4.0 4.1 Choudhry, Aditi; DeLoughery, Thomas G. (2012). "Bleeding and thrombosis in acute promyelocytic leukemia". American Journal of Hematology. 87 (6): 596–603. doi:10.1002/ajh.23158. ISSN 0361-8609.
  5. Choudhry, Aditi; DeLoughery, Thomas G. (2012). "Bleeding and thrombosis in acute promyelocytic leukemia". American Journal of Hematology. 87 (6): 596–603. doi:10.1002/ajh.23158. ISSN 0361-8609.
  6. Breen, Karen A.; Grimwade, David; Hunt, Beverley J. (2012). "The pathogenesis and management of the coagulopathy of acute promyelocytic leukaemia". British Journal of Haematology. 156 (1): 24–36. doi:10.1111/j.1365-2141.2011.08922.x. ISSN 0007-1048.
  7. 7.0 7.1 7.2 Vu K, Luong NV, Hubbard J, Zalpour A, Faderl S, Thomas DA; et al. (2015). "A retrospective study of venous thromboembolism in acute leukemia patients treated at the University of Texas MD Anderson Cancer Center". Cancer Med. 4 (1): 27–35. doi:10.1002/cam4.332. PMC 4312115. PMID 25487644.
  8. Al-Ani, F., Ahrari, A., Wang, Y. P., Iansavitchene, A., & Lazo-Langner, A. (2017). Incidence of Venous Thromboembolism in Acute Leukemia: A Systematic Review and Meta-Analysis. Blood, 130(Suppl 1), 5634. Accessed January 15, 2019. Retrieved from http://www.bloodjournal.org/content/130/Suppl_1/5634.
  9. Dicke, Christina; Amirkhosravi, Ali; Spath, Brigitte; Jiménez-Alcázar, Miguel; Fuchs, Tobias; Davila, Monica; Francis, John L; Bokemeyer, Carsten; Langer, Florian (2015). "Tissue factor-dependent and -independent pathways of systemic coagulation activation in acute myeloid leukemia: a single-center cohort study". Experimental Hematology & Oncology. 4 (1). doi:10.1186/s40164-015-0018-x. ISSN 2162-3619.
  10. Lima, Luize G.; Monteiro, Robson Q. (2013). "Activation of blood coagulation in cancer: implications for tumour progression". Bioscience Reports. 33 (5): 701–710. doi:10.1042/BSR20130057. ISSN 0144-8463.
  11. . doi:10.1182/blood-2016-09-739334 PMCID: PMC5374289 Check |doi= value (help). Missing or empty |title= (help)
  12. Periayah MH, Halim AS, Mat Saad AZ (October 2017). "Mechanism Action of Platelets and Crucial Blood Coagulation Pathways in Hemostasis". Int J Hematol Oncol Stem Cell Res. 11 (4): 319–327. PMC 5767294. PMID 29340130.
  13. Flores, Brisas; D Trivedi, Hirsh; C Robson, Simon; Bonder, Alan (2017). "Hemostasis, bleeding and thrombosis in liver disease". Journal of Translational Science. 3 (3). doi:10.15761/JTS.1000182. ISSN 2059-268X.
  14. Avvisati, Giuseppe (2011). "HOW I TREAT NEWLY DIAGNOSED ACUTE PROMYELOCYTIC LEUKEMIA". Mediterranean Journal of Hematology and Infectious Diseases. 3 (1): e2011064. doi:10.4084/mjhid.2011.064. ISSN 2035-3006.
  15. Fang, Shirong; Yang, Jinhong; Song, Lei; Jiang, Yan; Liu, Yuxiu (2017). "Comparison of three types of central venous catheters in patients with malignant tumor receiving chemotherapy". Patient Preference and Adherence. Volume 11: 1197–1204. doi:10.2147/PPA.S142556. ISSN 1177-889X.
  16. Dally, Najib; Hoffman, Ron; Haddad, Nuhad; Sarig, Galit; Rowe, Jacob M.; Brenner, Benjamin (2005). "Predictive factors of bleeding and thrombosis during induction therapy in acute promyelocytic leukemia—a single center experience in 34 patients". Thrombosis Research. 116 (2): 109–114. doi:10.1016/j.thromres.2004.11.001. ISSN 0049-3848.
  17. Handigund, Rajeshwari Satish; Malur, Prakash R.; Dhumale, Annasaheb J.; Bali, Akshay; Roy, Maitrayee; Inumella, Suvarna (2012). "Severe Aplastic Anemia Manifesting After Complete Remission of Acute Promyelocytic Leukemia: Is it a Fortuitous Association?". Indian Journal of Hematology and Blood Transfusion. 30 (1): 64–67. doi:10.1007/s12288-012-0201-8. ISSN 0971-4502.
  18. Bittencourt, Henrique; Teixeira Junior, Antonio Lucio; Glória, Ana Beatriz Firmato; Ribeiro, Ana Flávia Leonardi Tiburcio; Fagundes, Evandro Maranhão (2011). "Acute promyelocytic leukemia presenting as an extradural mass". Revista Brasileira de Hematologia e Hemoterapia. 33 (6): 478–480. doi:10.5581/1516-8484.20110126. ISSN 1516-8484.
  19. Fibach, Eitan; Rachmilewitz, Eliezer A. (2017). "Iron overload in hematological disorders". La Presse Médicale. 46 (12): e296–e305. doi:10.1016/j.lpm.2017.10.007. ISSN 0755-4982.
  20. Sanz, M. A.; Montesinos, P. (2014). "How we prevent and treat differentiation syndrome in patients with acute promyelocytic leukemia". Blood. 123 (18): 2777–2782. doi:10.1182/blood-2013-10-512640. ISSN 0006-4971.
  21. 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.
  22. Rego, Eduardo Magalhães; De Santis, Gil Cunha (2011). "DIFFERENTIATION SYNDROME IN PROMYELOCYTIC LEUKEMIA : CLINICAL PRESENTATION, PATHOGENESIS AND TREATMENT". Mediterranean Journal of Hematology and Infectious Diseases. 3 (1): e2011048. doi:10.4084/mjhid.2011.048. ISSN 2035-3006.
  23. 23.0 23.1 23.2 McCulloch D, Brown C, Iland H (2017). "Retinoic acid and arsenic trioxide in the treatment of acute promyelocytic leukemia: current perspectives". Onco Targets Ther. 10: 1585–1601. doi:10.2147/OTT.S100513. PMC 5359123. PMID 28352191.
  24. Sanz, M. A.; Montesinos, P. (2014). "How we prevent and treat differentiation syndrome in patients with acute promyelocytic leukemia". Blood. 123 (18): 2777–2782. doi:10.1182/blood-2013-10-512640. ISSN 0006-4971.
  25. 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.
  26. Porta‐Sánchez, Andreu; Gilbert, Cameron; Spears, Danna; Amir, Eitan; Chan, Joyce; Nanthakumar, Kumaraswamy; Thavendiranathan, Paaladinesh (2017). "Incidence, Diagnosis, and Management of QT Prolongation Induced by Cancer Therapies: A Systematic Review". Journal of the American Heart Association. 6 (12). doi:10.1161/JAHA.117.007724. ISSN 2047-9980.
  27. Barbey, Jean T.; Pezzullo, John C.; Soignet, Steven L. (2003). "Effect of Arsenic Trioxide on QT Interval in Patients With Advanced Malignancies". Journal of Clinical Oncology. 21 (19): 3609–3615. doi:10.1200/JCO.2003.10.009. ISSN 0732-183X.
  28. McCulloch, Derek; Brown, Christina; Iland, Harry (2017). "Retinoic acid and arsenic trioxide in the treatment of acute promyelocytic leukemia: current perspectives". OncoTargets and Therapy. Volume 10: 1585–1601. doi:10.2147/OTT.S100513. ISSN 1178-6930.
  29. McGowan, John V; Chung, Robin; Maulik, Angshuman; Piotrowska, Izabela; Walker, J Malcolm; Yellon, Derek M (2017). "Anthracycline Chemotherapy and Cardiotoxicity". Cardiovascular Drugs and Therapy. 31 (1): 63–75. doi:10.1007/s10557-016-6711-0. ISSN 0920-3206.
  30. Shakir, Douraid (2009). "Chemotherapy Induced Cardiomyopathy: Pathogenesis, Monitoring and Management". Journal of Clinical Medicine Research. doi:10.4021/jocmr2009.02.1225. ISSN 1918-3003.
  31. Coombs, C C; Tavakkoli, M; Tallman, M S (2015). "Acute promyelocytic leukemia: where did we start, where are we now and the future". Blood Cancer Journal. 5 (4): e304–e304. doi:10.1038/bcj.2015.25. ISSN 2044-5385.
  32. Efficace, Fabio; Breccia, Massimo; Avvisati, Giuseppe; Cottone, Francesco; Intermesoli, Tamara; Borlenghi, Erika; Carluccio, Paola; Rodeghiero, Francesco; Fabbiano, Francesco; Luppi, Mario; Romani, Claudio; Sborgia, Marco; D’Ardia, Stefano; Nobile, Francesco; Cantore, Nicola; Crugnola, Monica; Nadali, Gianpaolo; Vignetti, Marco; Amadori, Sergio; Lo Coco, Francesco (2018). "Health-related quality of life, symptom burden, and comorbidity in long-term survivors of acute promyelocytic leukemia". Leukemia. doi:10.1038/s41375-018-0325-4. ISSN 0887-6924.
  33. Park J, Jurcic JG, Rosenblat T, Tallman MS (2011). "Emerging new approaches for the treatment of acute promyelocytic leukemia". Ther Adv Hematol. 2 (5): 335–52. doi:10.1177/2040620711410773. PMC 3573416. PMID 23556100.
  34. 34.0 34.1 Abaza Y, Kantarjian H, Garcia-Manero G, Estey E, Borthakur G, Jabbour E; et al. (2017). "Long-term outcome of acute promyelocytic leukemia treated with all-trans-retinoic acid, arsenic trioxide, and gemtuzumab". Blood. 129 (10): 1275–1283. doi:10.1182/blood-2016-09-736686. PMC 5413297. PMID 28003274.

Linked-in.jpg