Management of acute promyelocytic leukemia: updated recommendations from an expert panel of the European LeukemiaNet.

Miguel A Sanz, Pierre Fenaux, Martin S Tallman, Elihu H Estey, Bob Löwenberg, Tomoki Naoe, Eva Lengfelder, Hartmut Döhner, Alan K Burnett, Sai-Juan Chen, Vikram Mathews, Harry Iland, Eduardo Rego, Hagop Kantarjian, Lionel Adès, Giuseppe Avvisati, Pau Montesinos, Uwe Platzbecker, Farhad Ravandi, Nigel H Russell, Francesco Lo-Coco

Journal: Blood 2019;133(15):1630-1643

PMID: 30803991

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Abstract

Since the comprehensive recommendations for the management of acute promyelocytic leukemia (APL) reported in 2009, several studies have provided important insights, particularly regarding the role of arsenic trioxide (ATO) in frontline therapy. Ten years later, a European LeukemiaNet expert panel has reviewed the recent advances in the management of APL in both frontline and relapse settings in order to develop updated evidence- and expert opinion-based recommendations on the management of this disease. Together with providing current indications on genetic diagnosis, modern risk-adapted frontline therapy, and salvage treatment, the review contains specific recommendations for the identification and management of the most important complications such as the bleeding disorder APL differentiation syndrome, QT prolongation, and other all- retinoic acid- and ATO-related toxicities, as well as recommendations for molecular assessment of the response to treatment. Finally, the approach to special situations is also discussed, including management of APL in children, elderly patients, and pregnant women. The most important challenges remaining in APL include early death, which still occurs before and during induction therapy, and optimizing treatment in patients with high-risk disease.

Address: Departamento de Hematologia, Hospital Universitari i Politècnic La Fe, Valencia, Spain.; Department of Medicine, University of Valencia, Valencia, Spain.; Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid, Spain.; Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.; Department of Hematology, Université Paris Diderot, Paris, France.; Memorial Sloan Kettering Cancer Center, New York, NY.; Seattle Cancer Care Alliance, Seattle, WA.; Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands.; National Hospital Organization Nagoya Medical Center, Nagoya, Japan.; Department of Haematology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany.; Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany.; Department of Haematology, Glasgow University, Glasgow, United Kingdom.; State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.; Department of Hematology, Christian Medical College, Vellore, India.; Royal Prince Alfred Hospital, Camperdown, NSW, Australia.; Hematology Division and.; Clinical Oncology Division, Department of Internal Medicine, University of Sao Paulo, Ribeirao Preto, Brazil.; Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX.; Hematology, Campus Bio-Medico University, Rome, Italy.; Departamento de Hematologia, Hospital Universitari i Politècnic La Fe, Valencia, Spain.; Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid, Spain.; Medical Clinic and Polyclinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany.; Centre for Clinical Haematology, Department of Haematology, Nottingham University Hospital, Nottingham, United Kingdom; and.; Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy.

DOI: 10.1182/blood-2019-01-894980

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MeSH Terms: Aged, Arsenic Trioxide, Disease Management, Female, Hemorrhagic Disorders, Humans, Leukemia, Promyelocytic, Acute, Practice Guidelines as Topic, Pregnancy, Recurrence, Tretinoin