Management of Acute Promyelocytic Leukemia at Extremes of Age

Käyser, Sabine; Conneely, Shannon E

doi:10.3390/cancers15143637

Cited by 2 publications

(1 citation statement)

References 52 publications

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“…This may suggest that patients with higher vulnerability to treatment toxicities may be allowed to continue receiving standard doses of these drugs if they survive early treatmentrelated mortality by reducing the drug dose. However, a small cohort analysis of elderly patients confirmed that suboptimal induction treatment with modified or reduced personalized approaches may lead to dismal outcomes [9]. Therefore, drugs such as venetoclax, a selective inhibitor of B-cell lymphoma 2 (BCL-2), which has been used successfully in the treatment of elderly patients with acute myeloid leukemia, may be worthy of further investigation.…”

Section: Discussionmentioning

confidence: 99%

Acute Promyelocytic Leukemia With Long and Short Isoforms of PML::RARA Fusion Transcripts Complicated by Abdominal Distension and Acute Edematous Pancreatitis During Induction Treatment: A Case Report

Chu,

Bai,

Wang

et al. 2024

Cureus

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The introduction of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) has transformed the outcome of acute promyelocytic leukemia (APL) from a uniformly fatal disease to one of the most curable human malignancies in recent decades. However, early mortality caused by coagulopathy, infection, multi-organ failure, and differentiation syndrome (DS) during disease onset and induction treatment remains a major issue in APL, especially in elderly patients who may suffer from higher treatment-related mortality due to a higher vulnerability to treatment toxicities. Herein, we present a case of an elderly patient with APL with rare mixed long (L-) and short (S-) isoforms of PML::RARA fusion transcripts who had multiple complications at disease onset. In addition, the initiation of treatment with ATRA in combination with ATO led to the rapid onset of severe DS. In particular, this patient experienced a rare clinical feature of DS, acute edematous pancreatitis (AEP). Furthermore, due to the patient's refractory abdominal distension related to the dose of ATRA, ATO, and Realgar-Indigo Naturalis Formula (RIF), we have to repeatedly adjust the doses of these drugs that the patient can maximally tolerate. Nevertheless, the patient achieved complete remission (CR) even after receiving a substandard dose of these drugs. However, the patient relapsed, acquired the FLT3-ITD mutation nine months later, and experienced abdominal distension again while receiving the standard doses of ATRA and RIF. Therefore, these drugs were adjusted to the maximum tolerated dose based on the experience with the initial induction treatment, and the patient achieved CR after four weeks of reinduction treatment. We report that this case may provide some clinical information for the diagnosis and treatment of similar patients with APL.

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Section: Discussionmentioning

confidence: 99%

Acute Promyelocytic Leukemia With Long and Short Isoforms of PML::RARA Fusion Transcripts Complicated by Abdominal Distension and Acute Edematous Pancreatitis During Induction Treatment: A Case Report

Chu,

Bai,

Wang

et al. 2024

Cureus

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MRD in Acute Leukemias: Lessons Learned from Acute Promyelocytic Leukemia

Kegyes,

Thiagarajan,

Ghiaur

2024

Cancers

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Introduction: Advances in molecular biology, polymerase chain reaction (PCR), and next-generation sequencing (NGS) have transformed the concept of minimal residual disease (MRD) from a philosophical idea into a measurable reality. Current Treatment Paradigms and Lessons Learned from APL: Acute promyelocytic leukemia (APL) leads the way in this transformation, initially using PCR to detect MRD in patients in remission, and more recently, aiming to eliminate it entirely with modern treatment strategies. Along the way, we have gained valuable insights that, when applied to other forms of acute leukemia, hold the potential to significantly improve the outcomes of these challenging diseases. Does the BM Microenvironment Play a Role in MRD?: In this review, we explore the current use of MRD in the management of acute leukemia and delve into the biological processes that contribute to MRD persistence, including its overlap with leukemia stem cells and the role of the bone marrow microenvironment.

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Management of Acute Promyelocytic Leukemia at Extremes of Age

Cited by 2 publications

References 52 publications

Acute Promyelocytic Leukemia With Long and Short Isoforms of PML::RARA Fusion Transcripts Complicated by Abdominal Distension and Acute Edematous Pancreatitis During Induction Treatment: A Case Report

Acute Promyelocytic Leukemia With Long and Short Isoforms of PML::RARA Fusion Transcripts Complicated by Abdominal Distension and Acute Edematous Pancreatitis During Induction Treatment: A Case Report

MRD in Acute Leukemias: Lessons Learned from Acute Promyelocytic Leukemia

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