Comanagement Strategy Between Academic Institutions and Community Practices to Reduce Induction Mortality in Acute Promyelocytic Leukemia

Abstract

PURPOSE: Acute promyelocytic leukemia (APL) is a curable leukemia with > 90% survival in clinical trials. Population-based studies from Sweden and US SEER data have shown long-term survival rates of 62% and 65.7%, with the lower rate being from a higher percentage of early deaths. METHODS: In this prospective, multicenter trial, we developed a simplified algorithm that focused on prevention and early treatment of the three main causes of death: bleeding, differentiation syndrome, and infection. All patients with a diagnosis of APL were included. The initial 6 months were spent educating oncologists about early deaths in APL. At the time of suspicion of an APL, an expert was contacted. The algorithm was made available followed by discussion of the treatment plan. Communication between expert and treating physician was frequent in the first 2 weeks, during which time most deaths take place. RESULTS: Between September 2013 and April 2016, 120 patients enrolled in the study from 32 hospitals. The median age was 52.5 years, with 39% > 60 years and 25% with an age-adjusted Charlson comorbidity index > 4. Sixty-three percent of patients were managed at community centers. Two patients did not meet the criteria for analysis, and of 118 evaluable patients, 10 died, with an early mortality rate of 8.5%. With a median follow-up of 27.3 months, the overall survival was 84.5%. CONCLUSION: Induction mortality can be decreased and population-wide survival improved in APL with the use of standardized treatment guidelines. Support from experts who have more experience with induction therapy is crucial and helps to improve the outcomes.

Characteristics and predictors of early hospital deaths in newly diagnosed APL: a 13-year population-wide study

“…Recent evidence has shown that a comanagement strategy between academic institutions and community practice may lower EDs to ,10%. 51 Because APL is rare, centralized expertise, with experience in providing supporting care and managing complications, is essential.…”

Acute promyelocytic leukemia current treatment algorithms

“…To minimize the early mortality in APL, Jillella et al designed a prospective multicenter clinical trial facilitating APL comanagement strategy between academic institutions and community oncology practices [ 23 ]. This approach allowed use of remote consultancy between APL experts and community oncologists treating patients with APL.…”

Practice patterns and real-life outcomes for patients with acute promyelocytic leukemia in the United States

“…Further, the outcomes of patients in clinical trials and population-based registry studies vary substantially. 4,5,[8][9][10][11][12] The factors underlying these survival differences are unknown. Prior studies have suggested survival differences based on patient demographics (age, race and socioeconomic status) and treatment setting, with more favorable outcomes observed for patients treated at academic or National Cancer Institute designated cancer centers.…”