Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Acute Promyelocytic Leukemia: a Single Center Study from Southern Pakistan

  • Sultan, Sadia (Department of Hematology and Blood Bank, Liaquat National Hospital and Medical College) ;
  • Irfan, Syed Mohammed (Department of Hematology and Blood Bank, Liaquat National Hospital and Medical College) ;
  • Ashar, Sana (Department of Hematology and Blood Bank, Liaquat National Hospital and Medical College)
  • Published : 2015.12.03
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Acute promyelocytic leukemia (APL) is a distinctive clinical, biological and molecular subtype of acute myeloid leukemia. However, data from Pakistan are scarce. Therefore we reviewed the demographic and clinical profile along with risk stratification of APL patients at our center. Materials and Methods: In this descriptive cross sectional study, 26 patients with acute promyelocytic leukemia were enrolled from January 2011 to June 2015. Data were analyzed with SPSS version 22. Results: The mean age was $31.8{\pm}1.68years$ with a median of 32 years. The female to male ratio was 2:1.2. The majority of our patients had hypergranular variant (65.4%) rather than the microgranular type. The major complaints were bleeding (80.7%), fever (76.9%), generalized weakness (30.7%) and dyspnea (15.38%). Physical examination revealed petechial rashes as a predominant finding detected in 61.5% followed by pallor in 30.8%. The mean hemoglobin was $8.04{\pm}2.29g/dl$ with the mean MCV of $84.7{\pm}7.72fl$. The mean total leukocyte count of $5.44{\pm}7.62{\times}10^9/l$; ANC of $1.08{\pm}2.98{\times}10^9/l$ and mean platelets count were $38.84{\pm}5.38{\times}10^9/l$. According to risk stratification, 15.3% were in high, 65.4% in intermediate and 19.2% in low risk groups. Conclusions: Clinico-epidemiological features of APL in Pakistani patients appear comparable to published data. Haemorrhagic diathesis is the commonest presentation. Risk stratification revealed predominance of intermediate risk disease.

Keywords

References

  1. Ambayya A, BBiomed, Zainina S, et al (2014). Antigen expression pattern of acute promyelocytic leukemia cases in Malaysia. Med J Malaysia, 69, 64-9.
  2. Avvisati G, Lo Coco F, Diverio D, et al (1996). AIDA (alltrans retinoic acid + idarubicin) in newly diagnosed acute promyelocytic leukemia: a Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto (GIMEMA) pilot study. Blood, 88, 1390-8.
  3. Bajpai J, Sharma A, Kumar L, et al (2011). Acute promyelocytic leukemia: An experience from a tertiary care centre in north India. Indian J Cancer, 48, 316-22. https://doi.org/10.4103/0019-509X.84938
  4. Breen KA, Grimwade D, Hunt BJ (2012). The pathogenesis and management of the coagulopathy of acute promyelocytic leukaemia. Br J Haematol, 156, 24-36. https://doi.org/10.1111/j.1365-2141.2011.08922.x
  5. Chen P, Huang HF, Lu R, Wu Y, Chen YZ (2012). Prognostic significance of CD44v6/v7 in acute promyelocytic leukemia. Asian Pac J Cancer Prev, 13, 3791-4. https://doi.org/10.7314/APJCP.2012.13.8.3791
  6. Chang H, Kuo MC, Shih LY, et al (2013). Acute promyelocytic leukemia-associated thrombosis. Acta Haematol, 130, 1-6. https://doi.org/10.1159/000345833
  7. Devita VT, Hellman S, Rosenberg SA (2008). Acute leukemias. DeVita VT, Rosenberg SA, Lawrence TS, eds. DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology. 8th ed. Philadelphia, Pa: Lippincott, Williams and Wilkins, 2, 2240-1.
  8. Dutta P, Sazawal S, Kumar R, Saxena R (2008). Does acute promyelocytic leukemia in Indian patients have biology different from the West? Indian J Pathol Microbiol, 51, 437-9. https://doi.org/10.4103/0377-4929.42555
  9. Duffield AS, Aoki J, Levis M, et al (2012). Clinical and pathologic features of secondary acute promyelocytic leukemia. Am J Clin Pathol, 137, 395-402. https://doi.org/10.1309/AJCPE0MV0YTWLUUE
  10. Esteve J, Escoda L, Marti n G, et al (2007). Spanish Cooperative Group PETHEMA. outcome of patients with acute promyelocytic leukemia failing to front-line treatment with all-trans retinoic acid and anthracycline-based chemotherapy (PETHEMA protocols LPA96 and LPA99): benefit of an early intervention. Leukemia, 21, 446-52. https://doi.org/10.1038/sj.leu.2404501
  11. Hillestad LK (1957). Acute promyelocytic leukemia. Acta Med Scand, 159, 189-94.
  12. Imani-Saber Z and Ghafouri-Fard S (2014). Promyelocytic leukemia gene functions and roles in tumorigenesis. Asian Pac J Cancer Prev, 15, 8021-8.
  13. Karim F, Shaikh U, Adil SN, Khurshid M (2014). Clinical characteristics, outcome and early induction deaths in patients with acute promyelocytic leukaemia: a five-year experience at a tertiary care centre. Singapore Med J, 55, 443-7. https://doi.org/10.11622/smedj.2014105
  14. Khorshid O, Diaa A, Moaty MA, et al (2011). Clinical features and treatment outcome of acute promyelocytic leukemia patients treated at cairo national cancer institute in egypt. Mediterr J Hematol Infect Dis, 3, 2011060. https://doi.org/10.4084/mjhid.2011.060
  15. Liang JY, Wu DP, Liu YJ, et al (2008). The clinical and laboratory features of acute promyelocytic leukemia: an analysis of 513 cases. Zhonghua Nei Ke Za Zhi, 47, 389-92.
  16. Lou Y, Ma Y, Suo S, et al (2015). Prognostic factors of patients with newly diagnosed acute promyelocytic leukemia treated with arsenic trioxide-based frontline therapy. Leuk Res, 39, 938-44 https://doi.org/10.1016/j.leukres.2015.05.016
  17. Mandegary A, Rostami S, Alimoghaddam K, Ghavamzadeh A, Ghahremani MH (2011). Gluthatione-S-transferase T1- null genotype predisposes adults to acute promyelocytic leukemia; a case-control study. Asian Pac J Cancer Prev, 12, 1279-82.
  18. Montesinos P, Rayon C, Vellenga E, PETHEMA; HOVON Groups, et al (2011). Clinical significance of CD56 expression in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and anthracycline-based regimens. Blood, 117, 1799-805. https://doi.org/10.1182/blood-2010-04-277434
  19. Mitrovic M, Suvajdzic N, Elezovic I, et al (2015). Thrombotic events in acute promyelocytic leukemia. Thromb Res, 135, 588-93. https://doi.org/10.1016/j.thromres.2014.11.026
  20. Park JH, Qiao B, Panageas KS, et al (2011). Early death rate in acute promyelocytic leukemia remains high despite all-trans retinoic acid. Blood, 118, 1248-54. https://doi.org/10.1182/blood-2011-04-346437
  21. Sanz MA, Lo Coco F, Marti n G, et al (2000). Definition of relapse risk and role of nonanthracycline drugs for consolidation in patients with acute promyelocytic leukemia: a joint study of the PETHEMA and GIMEMA cooperative groups. Blood, 96, 1247-53.
  22. Ziaei JE (2004). High frequency of acute promyelocytic leukemia in northwest Iran. Asian Pac J Cancer Prev, 5, 188-9.