Analysis Of Clinical Characteristics And Therapeutic Efficacy In Newly Diagnoesd Acute Promyelocytic Leukemia With High WBC Counts

Objective: To study the clinical characteristics and therapeutic efficacy of the newlydiagnoesd acute promyelocytic leukemia with high WBC counts. To compare thedifferences of the clinical characteristics and therapeutic efficacy in patients who hadthe different initial WBC counts.Methods: Between January,2009and December,2013,174patients of newlydiagnosed APL were enrolled in this study. All patients were diagnosed by MICM.106cases were male, and68cases were female. The age ranged form13to73years,the average age was39.6years and the median age was39.5years. According to theWBC counts at diagnosed, the patients were divided into three groups, patients withWBC <10×109/L, patients with WBC(10~50)×109/L and patients with WBC>50×109/L.The induction therapy mainly used ATRA and (or) As2O3, according to theWBC counts at diagnosed and during the therapy, the patients were considered to usehydroxycarbamide, low-dose cytarabine and anthracycline. To analysis the rate ofpatients had WBC higher than10×109/L, clinical characteristics and therapeuticefficacy of the174patients.Results:174patients of newly diagnosed APL were enrolled in this study,57patients(32.8%）had initial WBC>10×109/L.117patients (67.2%),36patients (20.7%), and21patients (12.1%) had initial WBC <10×109/L, WBC(10~50)×109/L and WBC>50×109/L. There was no significant difference among three groups on hemoglobinlevel (P=0.317), platelet count(P=0.616), activated partial thromboplastin time(P=0.746), fibrinogen level(P=0.177), the percentage of the patients with hemoglobin<80g/L（P=0.465）and platelet count<40×109/L（P=0.557）, but the prothrombin time（P=0.043）, the percentage of the patients with FBG <1.5g/L（P=0.029） andFBG<1.0g/L（P=0.034) was significant difference among three groups.22.9%,42.4%, and45%patients had the short PML-RARa isoform in these three groups, there wassignificant difference for different groups (P=0.027).5.7%,19%, and58.3%patientshad FLT3mutation in these three groups, there was significant difference for differentgroups(P<0.01).21.3%vs8.9%（P=0.071）patients had CD56expression with initialWBC <10×109/L and WBC>10×109/L.8.3%,12.9%and25%patients had additionalchromosomal abnormalities in these three groups, only one patient had the otherstructural chromosome with initial WBC <10×109/L, there was no significantdifference for different groups(P=0.088). In the174patients of newly diagnosed APL,28patients gave up therapy,146patients received the therapy,8patients (5.5%)died.138patients(94.5%) achieved complete remission. In the8dead patients,6patients(75%) died from cerebral hemorrhage, one patient died form infectious shock,and one patient died form respiratory failure. The CR rate was97.1%,92.9%and80%for the patients had initial WBC <10×109/L, WBC (10~50)×109/L and WBC>50×109/L. There was significant difference among three groups on CR rate (P=0.023).The ED rate was2.9%,7.1%and20%for the patients had initial WBC <10×109/L,WBC(10~50)×109/L and WBC>50×109/L. There was significant difference amongthree groups on ED rate (P=0.023). The time form the beginning of the therapy toachieve CR was（26.7±4.6）days. The time form the beginning of the therapy toachieve CR for three groups wa（s27.0±4.9)days（,26.0±3.7）days, and（25.0±3.9)days(P=0.590). The time of fibrinogen returned to more than1.5g/L for three groups was（4.0±4.4) days,（5.1±3.8）days, and（7.1±3.3）days(P=0.109).Conclusions: In this study, the percentage of newly diagnoesd acute promyelocyticleukemia patients with high WBC counts was32.8%, the patients was oftenassociated with the severer primary hyperfibrinolysis, with the short PML-RARaisoform, with the FLT3mutation. Early death rates was higher than the APL patientswith initial WBC <10×109/L, CR rates was lower than the APL patients with initialWBC <10×109/L.