Clinical Characteristics And Induction Chemotherapy Of Acute Promyelocytic Leukemia

PART1Analysis of early death factors and prognosis of acute promyelocytic leukemiaObjective To summarize the clinical characteristics of patients with de novo acute promyelocytic leukemia(APL)and patients with early death,analyze the risk factors and direct causes of early death,and survival analysis was performed.Methods The clinical data of 368 patients with de novo APL between January 2011 to December 2017 were retrospectively analyzed.The risk factors for early death were analyzed by logistic regression.The survival and prognosis of APL patients was analyzed.Results Of the 368 newly diagnosed APL patients,31 died early with an early mortality rate of 8.4%.The median time from diagnosis to death was 7(0-29)days.The clinical characteristics of patients with early death and non-early death were compared.Multivariate analysis using Logistic regression model showed that age?50 years and WBC?10×109/L were independent risk factors for early death in de novo APL patients(P<0.01).Analysis of the immediate cause of early death,a total of 27(87.1%)of the 31 early death was directly attributed to bleeding.Bleeding was the only cause of death in young patients,the major cause of death in elderly patients,and early death caused by other causes only occured in elderly patients.Comparing the clinical characteristics of patients with early hemorrhagic death and patients with non-hemorrhagic early death,suggesting that the median age and indirect bilirubin of patients with early hemorrhagic death were lower than those with non-hemorrhagic early death(P<0.05).The median follow-up time for all patients was 41(0.3-101.4)months.The 2-year overall survival rate(OS rate)was 93.5±1.3%,and the 5-year OS rate was 91.0 ± 1.5%.The 2-year disease-free survival rate(DFS rate)was 98.8± 0.6%,and the 5-year DFS rate was 97.1 ± 0.9%.The 2-year OS rate of elderly patients and younger patients was 79.3%vs 94.2%,P=0.000;the 2-year DFS rate was 92.3%vs 98.1%,P=0.023,The 2-year OS rate of high-risk and non-high-risk patients was 77.3%vs 96.7%,P=0.000;the 2-year DFS rate was 94.0%vs 98.4%,P=0.139.Conclusion Elderly and high risk APL patients need to pay attention to their risk of early death.The main cause of early death in de novo APL is bleeding.Elderly patients also need to actively deal with complications such as infection and differentiation syndrome.In addition to reducing early mortality in elderly patients,there is still room for improvement in subsequent treatment options.The adverse effects of high-risk patients'prognosis are mainly at high risk of early death.Taking individualized treatment strategies for newly diagnosed APL may obtain better results.PART 2Efficacy and safety evaluation of different doses of anthracyclines in the induction therapy for newly diagnosed acute promyelocytic leukemiaObjective To investigate the efficacy and safety of induction regimens containing arsenite(ATO),all-trans retinoic acid(ATRA)and anthracyclines in different doses as induction chemotherapy for acute promyelocytic leukemia(APL).Methods From January 2011 to December 2017,129 consecutive hospitalized newly diagnosed APL patients were retrospectively analyzed.Of them,66 patients received arsenite,ATRA and anthracyclines in low doses as induction chemotherapy(low dose group).While another 63 patients received arsenite,ATRA and anthracyclines in standard doses as induction chemotherapy(standard dose group).Results There were no statistically significant differences in terms of age,gender,ECOG,infection,routine blood indexes,LDH,promyelocytic ratio of peripheral blood and bone marrow,risk stratification between the two groups(P>0.05).Both induction regimens showed superior efficacy.The rate of molecular remission,incidence of differentiation syndrome,the 2-year overall survival and disease free survival in the low dose group were similar to those in the standard dose group(P>0.05).The recovery time of neutrophils and platelets in the low dose group was 0d and 11d,respectively,which was statistically significantly shorter than those in the standard dose group(3d,15d)(both P=0.000).The median value of platelet and erythrocyte transfusion in the low dose group was 6 U and 4 U,respectively,which were statistically significantly lower than that in the standard dose group(8 U,7 U)(P<0.05).The incidence rate of infection was much lower in the low dose group(27.3%vs 44.4%in the standard dose group;P=0.042).Conclusion For patients newly diagnosed with APL,there was indiscrimination of efficacy between induction therapy containing ATO,ATRA and low dose anthracyclines with the therapy containing ATO,ATRA and standard dose anthracyclines,and the former regimen appears even safer.