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, 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
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-trans 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.
Conflict of interest statement
Conflict-of-interest disclosure: M.A.S. received honoraria from Teva, Daiichi-Sankyo, Orsenix, AbbVie, Novartis, and Pfizer. M.S.T. received research funding from AbbVie, AROG, Cellerant, Orsenix, ADC Therapeutics, and Biosight, and served on advisory boards for Daiichi-Sankyo, Orsenix, KAHR, Rigel, AbbVie, and Nohla. E.L. received honoraria from, and served on advisory boards for, Teva and Novartis. H.I. received honorarium from Celgene, and served on an advisory board for Novartis. E.R. served on speaker’s bureaus for, and received honoraria from, Novartis, Janssen, Roche, and AbbVie. G.A. received honoraria from Takeda, Janssen, Teva, Roche, and Servier. P.M. served on speaker’s bureaus and/or advisory boards for AbbVie, Celgene, Daiichi-Sankyo, Incyte, Janssen, Karyopharm, Novartis, Pfizer, and Teva, and received research support from Celgene, Daiichi-Sankyo, Janssen, Karyopharm, Pfizer, and Teva. U.P. received honoraria from Celgene, Novartis, and Teva, and research support from Celgene, Janssen, Amgen, and Teva. F.L.-C. received honoraria from Teva, Daiichi-Sankyo, Orsenix, and Novartis. The remaining authors declare no competing financial interests.
© 2019 by The American Society of Hematology.
Source: PubMed