Treatment of patients with acute promyelocytic leukemia using AIDA regiments: 20 years long single center experience

  • Mirjana Mitrovic University of Belgrade, Faculty of Medicine, Department of Internal Medicine, Belgrade, Serbia https://orcid.org/0000-0001-8313-3754
  • Nikica Sabljic University Clinical Center of Serbia, Clinic of Hematology, Belgrade, Serbia https://orcid.org/0000-0001-5488-126X
  • Nikola M Pantic Clinic of Hematology, University Clinical Center of Serbia https://orcid.org/0000-0001-7798-4026
  • Lazar Trajkovic University Clinical Center of Serbia, Clinic of Hematology, Belgrade, Serbia https://orcid.org/0009-0009-7130-1912
  • Zoran Bukumiric University of Belgrade, Faculty of Medicine, Institute of Medical Statistics and Informatics, Belgrade, Serbia https://orcid.org/0000-0002-7609-4504
  • Marijana Virijevic University of Belgrade, Faculty of Medicine, Department of Internal Medicine, Belgrade, Serbia https://orcid.org/0000-0003-4626-4215
  • Zlatko Pravdic University Clinical Center of Serbia https://orcid.org/0000-0001-5095-7327
  • Ljubomir Jakovic University Clinical Center of Serbia, Clinic of Hematology, Belgrade, Serbia https://orcid.org/0000-0003-2400-0112
  • Jelica Jovanovic University Clinical Center of Serbia, Clinic of Hematology, Belgrade, Serbia
  • Nada Kraguljac Kurtovic University Clinical Center of Serbia, Clinic of Hematology, Belgrade, Serbia https://orcid.org/0000-0001-9182-3229
  • Violeta Milosevic University Clinical Center of Serbia, Clinic of Hematology, Belgrade, Serbia
  • Jovan Rajic University Clinical Center of Serbia, Clinic of Hematology, Belgrade, Serbia
  • Mirjana Cvetkovic University Clinical Center of Serbia, Clinic of Hematology, Belgrade, Serbia https://orcid.org/0000-0002-0907-7552
  • Vesna Djordjevic University Clinical Center of Serbia, Clinic of Hematology, Belgrade, Serbia
  • Vesna Knezevic University Clinical Center of Serbia, Clinic of Hematology, Belgrade, Serbia
  • Tijana Dragovic Ivancevic University Clinical Center of Serbia, Clinic of Hematology, Belgrade, Serbia
  • Sandra Bizic Radulovic University Clinical Center of Serbia, Clinic of Hematology, Belgrade, Serbia
  • Natasa Tosic University of Belgrade, Institute of Molecular Genetics and Genetic Engineering, Belgrade, Serbia
  • Ilija Doknic University of Novi Sad, Faculty of Sciences, Novi Sad, Serbia
  • Ana Vidovic University of Belgrade, Faculty of Medicine, Department of Internal Medicine, Belgrade, Serbia https://orcid.org/0000-0002-9916-2602
  • Andrija Bogdanovic University of Belgrade, Faculty of Medicine, Department of Internal Medicine, Belgrade, Serbia https://orcid.org/0000-0002-8288-7308
  • Nada Suvajdzic Vukovic University of Belgrade, Faculty of Medicine, Department of Internal Medicine, Belgrade, Serbia https://orcid.org/0000-0002-8807-4797
DOI: https://doi.org/10.5937/medi0-56551
Keywords: acute promyelocytic leukemia, early death, relapse

Abstract


Introduction: The introduction of all-trans retinoic acid (ATRA) has transformed acute promylocitic leucaemia (APL) from a highly fatal to a curable disease. However, a significant frequency of early death (ED) and relapse represents challenges in everyday practice. The aims of this study are to report our 20-year-long experience using AIDAbased protocols and to assess the predictive value of clinical and laboratory
parameters for ED/relapse development.


Material and methods: This retrospective study included patients treated at the Clinic for Hematology, UKCS, in the period 2004-2024. RS was defined as death within the first 30 days of hospitalization.


Results: 158 patients were included. ED and relapse occurred in 38/158 (24%) and 15/119 (12.6%) patients. ED rate stayed stable through time (2004-2008 period 20.6%, 2009–2013 21.9%, 2014–2018 23.1%, 2019– 2024 27%) with bleeding as the most frequent cause (42%), followed by DS (24%) and infection (16%). Final predictors for ED development were ISTH DIC score (p=0.008, OR 2.380, 95% CI 1.249-4.533), aPTT
(p=0.009, OR 0.786, 95% CI 0.656-0.941), ECOG PS (p=0.000, OR 2.964, 95% CI 1.630-0.988). Predictors for relapse were: ECOG PS ≥ 3 1(21.7% vs 78.3%, p=0.019) and bcr3 PML-RARA transcript (29.6% vs 70.4%, p=0.046).


Conclusion: Our experience showed a very high rate of ED, with haemorrhage, DS and infection as a main reason. Preventive strategies should include comprehensive medical education, regarding prompt recognition, appropriate early transfusion support therapy, and the rapid initiation of ATRA. Patients with high ECOG PS and ISTH DIC score probably need different coagulation monitoring and reinvented therapy.

Published
2025/09/24
Issue
Vol. 58 No. 3 (2025): Medical Research
Section
Članci