Forskning
Udskriv Udskriv
Switch language
Rigshospitalet - en del af Københavns Universitetshospital
Udgivet

Addressing the room for improvement in management of acute promyelocytic leukemia

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Harvard

APA

CBE

MLA

Vancouver

Author

Bibtex

@article{1e4deae954334bc79620510c08cf2577,
title = "Addressing the room for improvement in management of acute promyelocytic leukemia",
abstract = "Acute promyelocytic leukemia (APL) is highly curable. To achieve high cure rates, targeted therapy with retinoic acid (ATRA) must be started promptly at time of suspected diagnosis. Early death rates (EDRs, ≤30 days from diagnosis) differ markedly in patients treated on clinical trials compared to the general population.OBJECTIVES AND METHODS: We used the comprehensive Danish National Acute Leukemia Registry (DNLR) to investigate the incidence, treatment, EDR, and long-term clinical outcome in APL between 2000 and 2014.RESULTS: Twenty-two of 41 deaths occurring in 122 APL patients were EDs which were primarily caused by intracranial hemorrhage, disseminated intravascular coagulation (DIC), sepsis, and multiorgan failure. The overall EDR was 18.0{\%}, whereas clinical trial participants had an EDR of 6.7{\%}. Fifteen patients recruited to the NCRI AML17 APL trial from 2010 to 2013 were younger and had decreased mortality (HR 0.18, CI 0.04-0.86, P = 0.02) compared to contemporarily treated patients (n = 15) not recruited to a clinical trial. Performance status, leukemia origin, and Sanz-score were independent prognostic variables.CONCLUSIONS: The very low EDR for on-trial patients is not observed in the general cohort of APL patients. Diagnostic awareness emerges as the greatest clinical challenge in management of APL.",
keywords = "Adolescent, Adult, Aged, Aged, 80 and over, Biomarkers, Tumor, Combined Modality Therapy, Denmark/epidemiology, Disease Management, Female, Humans, In Situ Hybridization, Fluorescence, Kaplan-Meier Estimate, Leukemia, Promyelocytic, Acute/diagnosis, Male, Middle Aged, Oncogene Proteins, Fusion/genetics, Proportional Hazards Models, Quality Improvement, Registries, Translocation, Genetic, Young Adult",
author = "N{\o}rgaard, {Jan M} and Friis, {Lone S} and Kristensen, {J{\o}rgen S} and Severinsen, {Marianne T} and Ingolf M{\o}lle and Marcher, {Claus W} and Peter M{\o}ller and Claudia Schoellkopf and Nielsen, {Ove J} and Preiss, {Birgitte S} and Andersen, {Mette K} and Eigil Kjeldsen and Medeiros, {Bruno C} and {\O}stg{\aa}rd, {Lene S G} and {Danish Acute Leukemia Group}",
note = "{\circledC} 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.",
year = "2019",
month = "6",
doi = "10.1111/ejh.13229",
language = "English",
volume = "102",
pages = "479--485",
journal = "European Journal of Haematology",
issn = "0902-4441",
publisher = "Wiley-Blackwell Munksgaard",
number = "6",

}

RIS

TY - JOUR

T1 - Addressing the room for improvement in management of acute promyelocytic leukemia

AU - Nørgaard, Jan M

AU - Friis, Lone S

AU - Kristensen, Jørgen S

AU - Severinsen, Marianne T

AU - Mølle, Ingolf

AU - Marcher, Claus W

AU - Møller, Peter

AU - Schoellkopf, Claudia

AU - Nielsen, Ove J

AU - Preiss, Birgitte S

AU - Andersen, Mette K

AU - Kjeldsen, Eigil

AU - Medeiros, Bruno C

AU - Østgård, Lene S G

AU - Danish Acute Leukemia Group

N1 - © 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

PY - 2019/6

Y1 - 2019/6

N2 - Acute promyelocytic leukemia (APL) is highly curable. To achieve high cure rates, targeted therapy with retinoic acid (ATRA) must be started promptly at time of suspected diagnosis. Early death rates (EDRs, ≤30 days from diagnosis) differ markedly in patients treated on clinical trials compared to the general population.OBJECTIVES AND METHODS: We used the comprehensive Danish National Acute Leukemia Registry (DNLR) to investigate the incidence, treatment, EDR, and long-term clinical outcome in APL between 2000 and 2014.RESULTS: Twenty-two of 41 deaths occurring in 122 APL patients were EDs which were primarily caused by intracranial hemorrhage, disseminated intravascular coagulation (DIC), sepsis, and multiorgan failure. The overall EDR was 18.0%, whereas clinical trial participants had an EDR of 6.7%. Fifteen patients recruited to the NCRI AML17 APL trial from 2010 to 2013 were younger and had decreased mortality (HR 0.18, CI 0.04-0.86, P = 0.02) compared to contemporarily treated patients (n = 15) not recruited to a clinical trial. Performance status, leukemia origin, and Sanz-score were independent prognostic variables.CONCLUSIONS: The very low EDR for on-trial patients is not observed in the general cohort of APL patients. Diagnostic awareness emerges as the greatest clinical challenge in management of APL.

AB - Acute promyelocytic leukemia (APL) is highly curable. To achieve high cure rates, targeted therapy with retinoic acid (ATRA) must be started promptly at time of suspected diagnosis. Early death rates (EDRs, ≤30 days from diagnosis) differ markedly in patients treated on clinical trials compared to the general population.OBJECTIVES AND METHODS: We used the comprehensive Danish National Acute Leukemia Registry (DNLR) to investigate the incidence, treatment, EDR, and long-term clinical outcome in APL between 2000 and 2014.RESULTS: Twenty-two of 41 deaths occurring in 122 APL patients were EDs which were primarily caused by intracranial hemorrhage, disseminated intravascular coagulation (DIC), sepsis, and multiorgan failure. The overall EDR was 18.0%, whereas clinical trial participants had an EDR of 6.7%. Fifteen patients recruited to the NCRI AML17 APL trial from 2010 to 2013 were younger and had decreased mortality (HR 0.18, CI 0.04-0.86, P = 0.02) compared to contemporarily treated patients (n = 15) not recruited to a clinical trial. Performance status, leukemia origin, and Sanz-score were independent prognostic variables.CONCLUSIONS: The very low EDR for on-trial patients is not observed in the general cohort of APL patients. Diagnostic awareness emerges as the greatest clinical challenge in management of APL.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Biomarkers, Tumor

KW - Combined Modality Therapy

KW - Denmark/epidemiology

KW - Disease Management

KW - Female

KW - Humans

KW - In Situ Hybridization, Fluorescence

KW - Kaplan-Meier Estimate

KW - Leukemia, Promyelocytic, Acute/diagnosis

KW - Male

KW - Middle Aged

KW - Oncogene Proteins, Fusion/genetics

KW - Proportional Hazards Models

KW - Quality Improvement

KW - Registries

KW - Translocation, Genetic

KW - Young Adult

U2 - 10.1111/ejh.13229

DO - 10.1111/ejh.13229

M3 - Journal article

VL - 102

SP - 479

EP - 485

JO - European Journal of Haematology

JF - European Journal of Haematology

SN - 0902-4441

IS - 6

ER -

ID: 58960200