TREATMENT OF NEWLY DIAGNOSED ACUTE PROMYELOCYTIC LEUKEMIA IN A PREGNANT WOMAN

Vestnik ◽  
2021 ◽  
pp. 8-12
Author(s):  
Р.М. Рамазанова ◽  
А.К. Косанова ◽  
Ж.С. Шерияздан ◽  
Г.А. Сабырбаева ◽  
Г.М. Жандыбаева ◽  
...  
Keyword(s):  
Pregnant Woman ◽  
Cesarean Delivery ◽  
Acute Promyelocytic Leukemia ◽  
Induction Chemotherapy ◽  
De Novo ◽  
Promyelocytic Leukemia ◽  
Newly Diagnosed ◽  
Consolidation Chemotherapy ◽  
Gestation Age

Описан клинический случай впервые выявленного острого промиелоцитарного лейкоза у 36-летней беременной женщины при сроке 16-17 нед. До родов ей проведены 2 курса химиотерапии по схеме AIDA: индукция ремиссии даунорубицин из расчета 60 мг/м - 2, 4, 6, 8 дни, АТRA 45мг/м с 1 по 15 дни, дексаметазон 2,5 мг/м х 2 р в день с 1- по 15 дни. Ремиссия достигнута после 1-го курса индукционной терапии. После завершения 2-го курса ХТ в периоде полной ремиссии острого промиелоцитарного лейкоза на сроке беременности 25 недель проведено кесарево сечение в условиях городского родильного дома. Через 2 нед после родоразрешения в условиях гематологического отделения проведены еще два курса консолидации ремиссии. Далее пациентка переведена на поддерживающую терапию согласно протоколу AIDA: АТRA 45мг/м с 1 по 15 дни каждые 3 месяца, Метотрексат 15 мг/м/сут еженедельно, 6-Меркаптопурин 50 мг/м/сут. В контрольных анализах миелограммы констатируется полная ремиссия - 2.5% бластных клеток при нормальном соотношении всех ростков кроветворения. The case of de novo acute promyelocyte leukemia in a 36 year old pregnant woman (gestation age 16-17 weeks) is described. Two courses of “AIDA” chemotherapy were performed. Remission was achieved after the first induction chemotherapy. A month after the second consolidation chemotherapy at gestation age 25 weeks a living premature fetus was delivered by means of Cesarean delivery. After the delivery two more consolidation courses and supportive chemotherapy were performed. The woman now has been on remission.

Single-agent arsenic trioxide in the treatment of children with newly diagnosed acute promyelocytic leukemia

Blood ◽  
2010 ◽  
Vol 115 (9) ◽  
pp. 1697-1702 ◽  
Author(s):  
Jin Zhou ◽  
Yingmei Zhang ◽  
Jinmei Li ◽  
Xiaoxia Li ◽  
Jinxiao Hou ◽  
...  
Keyword(s):  
Arsenic Trioxide ◽  
Acute Promyelocytic Leukemia ◽  
De Novo ◽  
Single Agent ◽  
Promyelocytic Leukemia ◽  
Common Side Effect ◽  
Remission Induction ◽  
Newly Diagnosed ◽  
Efficacy And Safety

Abstract The aim of this study was to determine the efficacy and safety of treatment of pediatric acute promyelocytic leukemia (APL) with single-agent arsenic trioxide (ATO). A total of 19 children (≤ 15 years of age) with newly diagnosed APL were treated with single-agent ATO for remission induction and postremission therapy. Seventeen of the children (89.5%) achieved complete hematologic remission, and 2 early deaths occurred from intracranial hemorrhage. ATO-induced leukocytosis was observed in 13 (68.4%) patients. Other ATO-related toxicities were minimal and transient. Postremission ATO therapy continued for 3 years; the most common side effect was ATO-induced neutropenia. With a median follow-up of 53 months (range, 23-76 months), the calculated 5-year overall survival and event-free survival were 83.9% and 72.7%, respectively, which are comparable with results achieved by the use of ATRA plus chemotherapy, which is the standard therapy for APL. No chronic arsenic toxicity or second malignancies were found during the follow-up period, and arsenic retention was not significant in patients off treatment more than 24 months. ATO resistance was observed in only 1 patient with a complex karyotype. The results indicate the high efficacy and safety of single-agent ATO regimens in the treatment of children with de novo APL.

scholarly journals Remission in Patients with Acute Promyelocytic Leukemia Treated with Arsenic Trioxide (varitrinox) As the First Line in Colombia

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 3-3
Author(s):  
Gustavo Milone ◽  
Samuel Sarmiento Doncel ◽  
Carol Agudelo Rico ◽  
Fabiola Vizcarra Reyes ◽  
Gina Alejandra Diaz Mosquera ◽  
...  
Keyword(s):  
High Risk ◽  
Arsenic Trioxide ◽  
Acute Promyelocytic Leukemia ◽  
Conflicts Of Interest ◽  
Promyelocytic Leukemia ◽  
Remission Induction ◽  
Intermediate Risk ◽  
Newly Diagnosed ◽  
First Line ◽  
Risk Patients

Acute promyelocytic leukemia (APL) is a subtype of Acute Myeloid Leukemia (AML) in which a chromosomal translocation t (15; 17) (q22; q12) is generated by fusing produces a hybrid PML / RARα gene, generating an altered signal . The combination of transretinoic acid (ATRA) plus arsenic trioxide (ATO) has been shown to be superior to ATRA plus chemotherapy in the treatment of newly diagnosed standard risk patients with acute promyelocytic leukemia (APL) in several countries. The objective of the present study is to describe the frequency of remission in patients with acute promyelocytic leukemia who were administered as a first line Arsenic Trioxide (varitrinox) during the period from November 2017 to June 2020 in Colombian patients. Methods: Retrospective observational and descriptive study of 12 patients diagnosed with acute promyelocytic leukemia treated with ATO Arsenic trioxide (Varitrinox) as first line, the source of information was provided by the treating hematologists (medical records) by filling out the technical concept format. Active pharmacovigilance scientist in Colombia, this format keeps the identification information of the patient anonymized and the confidentiality of the data is guaranteed as well as compliance with the rules of good clinical practice. Results: Twelve patients with age range between 22 and 69 years with a median age of 34.0 were analyzed. It was found in the analysis that 100% had induction hematologic remission with a median of 45 days. 75% of patients received ATO + ATRA and were at low and intermediate risk, the remaining 25% received ATRA + ATO + Chemotherapy and were at high risk, and intermediate risk. 91.7% of molecular remission in consolidation was obtained and it was measured in cycle 3 by means of PCR (undetectable), 8.3% (n = 1) was positive 3% and is finishing consolidation. Regarding the most frequent adverse events, intravascular coagulation (n = 9), neutropenia (n = 6) and thrombocytopenia (n = 6) were observed. 75% of patients are disease-free, 16.7% are on maintenance (they received ATO + ATRA + Induction chemotherapy) and 8.3% are on consolidation. So far, none of the patients under study have died. Conclusions: Our results support the use of ATO (Varitrinox) in newly diagnosed APL patients (as first line), as a care strategy for low, intermediate and high risk patients. The role of ATRA-ATO is guaranteed in other studies where they manage patients of different risks. Key words: Arsenic trioxide, leukemia promyelocytic acute, leukemia myeloid acute, remission induction, tretinoin. Disclosures No relevant conflicts of interest to declare.

scholarly journals ASLAN003, a potent dihydroorotate dehydrogenase inhibitor for differentiation of acute myeloid leukemia

Haematologica ◽  
2019 ◽  
Vol 105 (9) ◽  
pp. 2286-2297 ◽  
Author(s):  
Jianbiao Zhou ◽  
Jessie Yiying Quah ◽  
Yvonne Ng ◽  
Jing-Yuan Chooi ◽  
Sabrina Hui-Min Toh ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Acute Promyelocytic Leukemia ◽  
Myeloid Leukemia ◽  
De Novo ◽  
Leukemia Cell ◽  
Promyelocytic Leukemia ◽  
Dihydroorotate Dehydrogenase ◽  
Isocitrate Dehydrogenase 1 ◽  
Pyrimidine Synthesis ◽  
Acute Myeloid

Differentiation therapies achieve remarkable success in acute promyelocytic leukemia, a subtype of acute myeloid leukemia. However, excluding acute promyelocytic leukemia, clinical benefits of differentiation therapies are negligible in acute myeloid leukemia except for mutant isocitrate dehydrogenase 1/2. Dihydroorotate dehydrogenase catalyses the fourth step of the de novo pyrimidine synthesis pathway. ASLAN003 is a highly potent dihydroorotate dehydrogenase inhibitor that induces differentiation, as well as reduces cell proliferation and viability, of acute myeloid leukemia cell lines and primary acute myeloid leukemia blasts including in chemo-resistant cells. Apoptotic pathways are triggered by ASLAN003, and it also significantly inhibits protein synthesis and activates AP-1 transcription, contributing to its differentiation promoting capacity. Finally, ASLAN003 substantially reduces leukemic burden and prolongs survival in acute myeloid leukemia xenograft mice and acute myeloid leukemia patient-derived xenograft models. Notably, the drug has no evident effect on normal hematopoietic cells and exhibits excellent safety profiles in mice, even after a prolonged period of administration. Our results, therefore, suggest that ASLAN003 is an agent targeting dihydroorotate dehydrogenase with potential in the treatment of acute myeloid leukemia. ASLAN003 is currently being evaluated in phase 2a clinical trial in acute myeloid leukemia patients.

Characterization of a rarely reported STAT5B/RARA gene fusion in a young adult with newly diagnosed acute promyelocytic leukemia with resistance to ATRA therapy

2019 ◽  
Vol 237 ◽  
pp. 51-54
Author(s):  
Jess F. Peterson ◽  
Rui R. He ◽  
Hassan Nayer ◽  
Raymund S. Cuevo ◽  
James B. Smadbeck ◽  
...  
Keyword(s):  
Young Adult ◽  
Acute Promyelocytic Leukemia ◽  
Gene Fusion ◽  
Promyelocytic Leukemia ◽  
Newly Diagnosed

Studies on Treatment of Acute Promyelocytic Leukemia With Arsenic Trioxide: Remission Induction, Follow-Up, and Molecular Monitoring in 11 Newly Diagnosed and 47 Relapsed Acute Promyelocytic Leukemia Patients

Blood ◽  
1999 ◽  
Vol 94 (10) ◽  
pp. 3315-3324 ◽  
Author(s):  
Chao Niu ◽  
Hua Yan ◽  
Ting Yu ◽  
Hui-Ping Sun ◽  
Jian-Xiang Liu ◽  
...  
Keyword(s):  
Arsenic Trioxide ◽  
Acute Promyelocytic Leukemia ◽  
Disease Free Survival ◽  
Promyelocytic Leukemia ◽  
Pcr Analysis ◽  
Remission Induction ◽  
Newly Diagnosed ◽  
First Choice ◽  
Wbc Count

Fifty-eight acute promyelocytic leukemia (APL) patients (11 newly diagnosed and 47 relapsed) were studied for arsenic trioxide (As2O3) treatment. Clinical complete remission (CR) was obtained in 8 of 11 (72.7%) newly diagnosed cases. However, As2O3 treatment resulted in hepatic toxicity in 7 cases including 2 deaths, in contrast to the mild liver dysfunction in one third of the relapsed patients. Forty of forty-seven (85.1%) relapsed patients achieved CR. Two of three nonresponders showed clonal evolution at relapse, with disappearance of t(15;17) and PML-RAR fusion gene in 1 and shift to a dominant AML-1-ETO population in another, suggesting a correlation between PML-RAR expression and therapeutic response. In a follow-up of 33 relapsed cases over 7 to 48 months, the estimated disease-free survival (DFS) rates for 1 and 2 years were 63.6% and 41.6%, respectively, and the actual median DFS was 17 months. Patients with white blood cell (WBC) count below 10 × 109/L at relapse had better survival than those with WBC count over 10 × 109/L (P = .038). The duration of As2O3-induced CR was related to postremission therapy, because there was only 2 of 11 relapses in patients treated with As2O3 combined with chemotherapy, compared with 12 of 18 relapses with As2O3 alone (P = .01). Reverse transcription polymerase chain reaction (RT-PCR) analysis in both newly diagnosed and relapsed groups showed long-term use of As2O3 could lead to a molecular remission in some patients. We thus recommend that ATRA be used as first choice for remission induction in newly diagnosed APL cases, whereas As2O3 can be either used as a rescue for relapsed cases or included into multidrug consolidation/maintenance clinical trials.

An effective early death scoring system for predicting early death risk in de novo acute promyelocytic leukemia

2020 ◽  
Vol 61 (8) ◽  
pp. 1989-1995 ◽  
Author(s):  
Ping Cai ◽  
Qian Wu ◽  
Yemin Wang ◽  
Xiaofei Yang ◽  
Xinyou Zhang ◽  
...  
Keyword(s):  
Acute Promyelocytic Leukemia ◽  
Scoring System ◽  
De Novo ◽  
Early Death ◽  
Promyelocytic Leukemia ◽  
Death Risk
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