Collaborative Initiation of Therapy for Patients with Acute Promyelocytic Leukemia

Acute promyelocytic leukemia (APL) is a rare, acute, and highly curable malignancy, yet up to 30% of patients die early after diagnosis from disease-related bleeding or complications exacerbated by delays in initiation of all-trans retinoic acid (ATRA)–based induction therapy. In an attempt to decrease early mortality to less than 15%, investigators developed an APL management program that involved rapid initiation of ATRA therapy and the use of a simplified induction treatment algorithm. Consultation from APL experts at academic centers was available to the community site providers around the clock from the time of diagnosis and throughout induction therapy. Six academic and 293 community medical centers across the U.S. participated.

Of 201 eligible patients, 62 were treated at academic, 139 at community sites. The median patient age was 53 years (range, 18–91), 26.4% were considered high-risk based on white blood cell count ≥10,000/dL, and 59% were obese. Only six patients (3%) died in the first month after diagnosis, including five who were aged 70 to 81. Five additional deaths occurred in year 1, one from a treatment complication and four unrelated to APL. Of 11 deaths after year 1, four were due to APL relapse.