Acute promyelocytic leukemia natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Natural History
Acute promyelocytic leukemia typically begins with a prodrome of symptoms including fatigue, bleeding, and infections (such as upper respiratory tract infection). Patients typically present to their primary care physician with such symptoms, and a complete blood count usually reveals a low white blood cell count, low hemoglobin, and low platelet count. A bone marrow biopsy is usually done to work up the abnormal laboratory values, and a diagnosis of acute promyelocytic leukemia is made. In the first few days to weeks of the disease, there is a high risk of bleeding due to disseminated intravascular coagulation, a condition characterized by abnormal thrombus formation and breakdown. The high early mortality rate was previously a major part of the natural history of the disease, prior to the advent of rapid diagnostic and therapeutic interventions for this disease.[1] In areas of the United States with limited healthcare or highly specialized academic centers, bleeding diathesis continues to remain a major part of the natural history of the disease. Such bleeding complications include gingival bleeding (very common), bruising (very common), epistaxis, menorrhagia (less common). In areas of the United States with readily available healthcare and specialized academic medical centers, the natural history of the disease takes a favorable trajectory, as the cure rate is quite high if appropriate induction therapy is initiated.[1]
Complications
Acute promyelocytic leukemia is frequently associated with bleeding caused by disseminated intravascular coagulation (DIC).
Prognosis
References
- ↑ 1.0 1.1 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.