46 patients with acute promyelocytic leukemia (APL) have been treated by ATRA (all trans retinoic acid). The result showed that 33 patients (72%) were complete remission. Two patients in relapse have been treated by ATRA plus As2O3 (arsenic trioside). The both patients were complete remission. The results of the present study showed that ATRA is standard drug of remission of induction in APL.
Leukemia, Promyelocytic, Acute ; therapy ; drug therapy ; therapeutics

BACKGROUND: For acute promyelocytic leukemia (APL), NCI criteria (1990) does not provide reliable information regarding therapeutic response. We studied APL cases in our hospital and evaluated various criteria for their predictability of therapeutic response. METHODS: Group I (GI) included 8 APL cases treated with chemotherapy and group II (GII), 10 cases with ATRA plus chemotherapy. Four treatment response indices were; (1) NCI criteria, (2) the percent sum of myelocyte and metamyelocyte (PSMM), (3) Differentiation Index[ (myelocyte+metamyelocyte+band neutrophil+segmented neutrophil)%/ (myeloblast+promyelocyte)%, DI], and (4) Maturation Index[ (metamyelocyte+band neutrophil+segmented neutrophil)%/ (myeloblast+promyelocyte+myelocyte)%, MI]. RESULTS: Among those achieving complete remission (CR), four of GI and eight of GII showed normocellularity or hypercellularity, two were in partial remission and three in persistence of GI by NCI criteria and one of GII showed persistent Auer rods at D14. Applying NCI criteria, the blast plus leukemic promyelocyte as leukemic cell were correlated well with clinical outcome. PSMM of GII were relatively constant as 20 to 29.7% at D28. DI showed wide variation and MI over 2 (Nakajima, 1996) did not correlate with CR by NCI criteria in 5 cases at D14 and 1 case at D28. CONCLUSION: NCI criteria are the reliable predictor of CR at D28 after chemotherapy if blasts plus leukemic promyelocytes are regarded as leukemic cell while they are inappropriate at D14. The persistence of Auer rods dose not exclude CR. After ATRA plus chemotherapy therapy, PSMM over 20% at D28 may be considered as a marker for CR.
Bone Marrow* ; Drug Therapy ; Granulocyte Precursor Cells ; Leukemia, Promyelocytic, Acute*

Acute myeloid leukemia (AML) is a rare type of childhood acute leukemia, which has a worse prognosis than childhood acute lymphoblastic leukemia. Over the past decade, significant progress has been made in the treatment of childhood AML and the 5-year event-free survival rate may be as high as 70% in developed countries. This survival improvement is largely attributable to risk-stratified treatments, therapies tailored to individual patients based on the biological characteristics of the disease, and continuously improving supportive care. An accurate diagnosis is the prerequisite for risk stratification, prognostic evaluation and therapeutic decision making. How to reduce early mortality and thus improve overall survival, how to implement appropriate supportive treatment to reduce treatment-associated complications, and how to reduce treatment-related mortality are the key to the improvement of therapies for childhood acute myeloid leukemia.
Child ; Humans ; Leukemia, Myeloid, Acute ; diagnosis ; drug therapy ; genetics ; mortality ; Leukemia, Promyelocytic, Acute ; drug therapy ; genetics

BACKGROUND: The combination of cytarabine plus anthracycline has been considered standard chemotherapy for acute myelogenous leukemia (AML). We retrospectively analyzed the treatment results of the patients with de novo AML who received cytarabine plus daunorubicin or idarubicin as induction chemotherapy. METHODS: From 1989 to 1998, 149 patients with AML were included. For induction chemotherapy, the patients received cytarabine 100~ 200 mg/m2/day given by continuous 7-day in fusion plus either daunorubicin 40~45 mg/m2/ day (A+D) or idarubicin 12 mg/m2/day (A+I) administered for the first 3 days of treatment. We reviewed clinical records of the patients and analyzed the treatment results such as complete remission (CR) rate, disease free survival (DFS), and overall survival (OS). RESULTS: The CR rates were 67.1% (100 of 149); 69.3% (70 of 101) in A+D group and 62.5 % (30 of 48) in A+I group (P=0.409). The frequent reason of induction failure was resistant disease in A+D group (54.8%) and early death in A+I group (66.7%). The median DFS was 344 days; 344 days in A+D group and 314 days in A+I group. The median OS was 379 days; 389 days in A+D group and 379 days in A+I group. Age < or =60 years and allogeneic BMT as postremission therapy were independent favorable factors both for DFS and OS. AML M3 was favorable factor only for DFS. CONCLUSION: The combination of cytarabine plus daunorubicin or idarubicin was effective for the treatment of AML. We can not find significant difference in CR rate, disease free survival and overall survival between A+D and A+I group.
Cytarabine* ; Daunorubicin* ; Disease-Free Survival ; Drug Therapy ; Humans ; Idarubicin* ; Induction Chemotherapy* ; Leukemia, Myeloid, Acute* ; Leukemia, Promyelocytic, Acute ; Retrospective Studies

Early diagnosis of acute promyelocytic leukemia (APL) depends primarily on morphological recognition before the presence of t(15;17) or PML-RAR gene rearrangement is confirmed. But the diagnosis is difficult to be made, if typical APL morphologic features are not found. Here, we describe a 32- year old man who had been diagnosed as APL. He relapsed with AML M1 like phenotype, lacking the typical features of APL. At relapse, t(15;17) and PML-RAR alpha gene rearrangement were detected. After 14 days of chemotherapy and all-trans retinoic acid, the phenotype changed from the AML M1 like features to the typical hypergranular APL. Awareness of atypical morphologic subtypes found in APL is important. And identification of t(15;17) or PML/RAR alpha rearrangement will be helpful in diagnosis of atypical APL.
Diagnosis ; Drug Therapy ; Early Diagnosis ; Gene Rearrangement ; Leukemia, Promyelocytic, Acute* ; Phenotype ; Recurrence* ; Tretinoin

Arsenicals ; therapeutic use ; Humans ; Leukemia, Promyelocytic, Acute ; drug therapy ; Medicine, Chinese Traditional ; Oxides ; therapeutic use

We repoarted a rare case of AML atypical M2 who developed granulocytic granulocyte sarcoma in the meninges which was induced complete remission with all-trans retinoic acid (ATRA), daunorubicin and cytosine arabinoside (Ara-C). Morphological and immunophenotypic study of leukemic cells in this patient suggested acute promyelocytic leukemia. However, leukemic clees lacked both t (15;17) and PML-RARalpha gene rearragement, rather showed t (8;21). The patient was diagnosed as AML atypical M2.
Cytarabine ; Daunorubicin ; Drug Therapy* ; Granulocytes ; Humans ; Leukemia, Promyelocytic, Acute ; Meninges* ; Sarcoma ; Sarcoma, Myeloid* ; Tretinoin*

OBJECTIVE: To investigate herpes zoster reactivation induced by arsenic in patients with acute promyelocytic leukemia (APL). METHODS: The clinical data of 212 patients with APL treated in the Department of Hematology of the First Affiliated Hospital of Xi'an Jiaotong University from 2008 to 2019 were retrospectively analyzed to observe the activation of varicella zoster virus induced by arsenic. Kaplan-Meier analysis, chi-square test, and boxplot were used to analyze and describe the cumulative dose of arsenic and the time from the beginning of arsenic treatment to the occurrence of herpes zoster. RESULTS: Excluding early death cases and early automatic discharge cases, 17 cases developed herpes zoster reactivation in 175 patients with APL treated with arsenic, and the cumulative median dose of arsenic was 6.2(2-12) mg/kg. Precise risk of reactivation of herpes zoster with 10 months in APL patients treated by arsenic was 9.7%. CONCLUSION Arsenic treatment can induce high reactivation rate of herpes zoster virus.
Arsenic ; Herpes Zoster/epidemiology* ; Herpesvirus 3, Human ; Humans ; Leukemia, Promyelocytic, Acute/drug therapy* ; Retrospective Studies

OBJECTIVETo investigate the efficacy of arsenic trioxide combined with all trans retinoic acid (ATRA) for patients with acute promyelocytic leukemia (APL).

METHODSA total of 159 cases of APL were selected from January 2011 to December 2014 in our hospital, among them 75 cases were treated by As₂O₃combined with ATRA, 43 cases were treated with As₂O₃alone, 41 cases were treated with ATRA alone. The cardiac enzymes level, lever function index change, death rate, complate remission (CR) rate, time of reaching CR and complicatiens were compared in 3 groups.

RESULTSAfter treatment of 8 courses, ALT and AST levels in As₂O₃+ ATRA group were significantly higher than those in As₂O₃and ATRA alone groups; the CK-MB and TnI-UI index increased in As₂O₃group (P < 0.05); as compared with As₂O₃group, the mortality and CR rate in As₂O₃+ ATRA group were no significant different, but the time of reaching CR was significantly shortened. For relapsed patients, the CR rate in As₂O₃+ ATRA group was no significantly different from that in As₂O₃group, while was significantly higher than that in ATRA group. The ratio of liver function damage in As₂O₃+ ATRA group was increased, moreover the incidence of leukocytosis and headache in ATRA group was significantly higher than that in As₂O₃+ ATRA and As₂O₃group (P < 0.05).

CONCLUSIONSThe efficacy of As₂O₃conbined with ATRA for inducing remission is better than that of single drug treatment, moreover the adverse reactions occur less.

Arsenicals ; therapeutic use ; Drug Therapy, Combination ; Humans ; Leukemia, Promyelocytic, Acute ; drug therapy ; Oxides ; therapeutic use ; Remission Induction ; Tretinoin ; therapeutic use

Adult ; Female ; Humans ; Leukemia, Promyelocytic, Acute ; complications ; drug therapy ; Sinus Thrombosis, Intracranial ; complications ; drug therapy ; Tretinoin ; therapeutic use