Differentiation syndrome and coagulation disorder - comparison between treatment with oral and intravenous arsenics in pediatric acute promyelocytic leukemia.

Autor: Luo JS; Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China., Zhang XL; Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China., Huang DP; Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China., Chen YQ; Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China., Wan WQ; Department of Pediatrics, Second Xiangya Hospital, Changsha, Hunan, China., Mai HR; Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, China., Chen HQ; Department of Pediatrics, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China., Wen H; Department of Pediatrics, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China., Liu RY; Department of Pediatrics, Huizhou Central People's Hospital, Huizhou, Guangdong, China., Chen GH; Department of Pediatrics, First People's Hospital of Huizhou, Huizhou, Guangdong, China., Li Y; Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China., Luo XQ; Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China., Tang YL; Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China. tangylai@mail.sysu.edu.cn., Huang LB; Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China. huanglb3@mail.sysu.edu.cn.
Jazyk: angličtina
Zdroj: Annals of hematology [Ann Hematol] 2023 Jul; Vol. 102 (7), pp. 1713-1721. Date of Electronic Publication: 2023 May 18.
DOI: 10.1007/s00277-023-05270-x
Abstrakt: Realgar-Indigo naturalis formula (RIF), with A 4 S 4 as a major ingredient, is an oral arsenic used in China to treat pediatric acute promyelocytic leukemia (APL). The efficacy of RIF is similar to that of arsenic trioxide (ATO). However, the effects of these two arsenicals on differentiation syndrome (DS) and coagulation disorders, the two main life-threatening events in children with APL, remain unclear. We retrospectively analyzed 68 consecutive children with APL from South China Children Leukemia Group-APL (SCCLG-APL) study. Patients received all-trans retinoic acid (ATRA) on day 1 of induction therapy. ATO 0.16 mg/kg day or RIF 135 mg/kg·day was administrated on day 5, while mitoxantrone was administered on day 3 (non-high-risk) or days 2-4 (high-risk). The incidences of DS were 3.0% and 5.7% in ATO (n = 33) and RIF (n = 35) arms (p = 0.590), and 10.3% and 0% in patients with and without differentiation-related hyperleukocytosis (p = 0.04), respectively. Moreover, in patients with differentiation-related hyperleukocytosis, the incidence of DS was not significantly different between ATO and RIF arms. The dynamic changes of leukocyte count between arms were not statistically different. However, patients with leukocyte count > 2.61 × 10 9 /L or percentage of promyelocytes in peripheral blood > 26.5% tended to develop hyperleukocytosis. The improvement of coagulation indexes in ATO and RIF arms was similar, with fibrinogen and prothrombin time having the quickest recovery rate. This study showed that the incidence of DS and recovery of coagulopathy are similar when treating pediatric APL with RIF or ATO.
(© 2023. The Author(s).)
Databáze: MEDLINE
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