Does leukocytosis remain a predictive factor for survival outcomes in patients with acute promyelocytic leukemia receiving ATRA plus a chemotherapy-based regimen? A prospective multicenter analysis from TALWG
Smith Kungwankiattichai,
Weerapat Owattanapanich,
Thanawat Rattanathammethee,
Ekarat Rattarittamrong,
Chantiya Chanswangphuwana,
Chantana Polprasert,
Wasithep Limvorapitak,
Supawee Saengboon,
Pimjai Niparuck,
Teeraya Puavilai,
Jakrawadee Julamanee,
Pirun Saelue,
Chinadol Wanitpongpun,
Kannadit Prayongratana,
Chantarapa Sriswasdi,
Chajchawan Nakhakes
Affiliations
Smith Kungwankiattichai
Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Weerapat Owattanapanich
Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Thanawat Rattanathammethee
Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Ekarat Rattarittamrong
Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Chantiya Chanswangphuwana
Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Chantana Polprasert
Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Wasithep Limvorapitak
Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Supawee Saengboon
Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Pimjai Niparuck
Division of Hematology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Teeraya Puavilai
Division of Hematology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Jakrawadee Julamanee
Division of Hematology, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
Pirun Saelue
Division of Hematology, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
Chinadol Wanitpongpun
Division of Hematology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Kannadit Prayongratana
Division of Hematology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
Chantarapa Sriswasdi
Division of Hematology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
Chajchawan Nakhakes
Division of Hematology, Department of Medicine, Rajavithi Hospital, Bangkok, Thailand
ABSTRACTIntroduction Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia (AML) with a unique clinical presentation and prognosis. This study aimed to investigate the epidemiology, clinical characteristics, treatments, and clinical outcomes of Thai APL patients dominantly treated with all-trans-retinoic acid (ATRA) combined with a chemotherapy-based therapy.Methods This was an eight-year prospective, observational study from nine academic hospitals in the Thai Acute Leukemia Working Group (TALWG) of the Thai Society of Hematology, which included newly diagnosed Thai APL patients, aged 18 years or older. The web-based registration collected baseline charateristic, and clinical outcomes.Results From 992 newly diagnosed AML patients, 79 APL patients were enrolled in this study. Almost all subjects were de novo APL (94.9%), while the others were therapy-related APL. The commonest clinical presentation was disseminated intravascular coagulation (38%). One-third of the patients were categorized as high risk according to the initial WBC. Almost all patients received ATRA combined with idarubicin regimen. The complete response rate was as high as 95.7%, which translated into excellent four-year overall survival (OS) (75.6%) and four-year leukemia-free survival (LFS) (75.4%). The multivariate analysis demonstrated that the older age and WBC count >20 × 109/L conferred a significantly unfavorable OS with the hazard ratios of 3.03 (95% confidence interval [CI]: 1.14–8.05) and 4.18 (95%CI: 1.69–10.35), respectively. Similarly, these two parameters remained independent of the poor prognosis factors for LFS.Conclusion This report confirmed that APL had a favorable prognosis. However, advanced age and high WBC count >20 × 109/L contributed to a worse outcome.Abbreviations APL; acute promyelocytic leukemia; ATRA; all-transretinoic acid; CR; complete remission; DS; differentiation syndrome; ECOG; Eastern Cooperative Oncology Group; ED; early death; HR; hazard ratio; IQR; interquartile range; LFS; leukemia-free survival; OS; overall survival; WBC; white blood cell.
