NOT ALL VARIANTS OF ACUTE PROMYELOCYTIC LEUKEMIAS ARE RESISTANT TO RETINOIDS. (EHA 2023)
He was found to have persistent leukocytosis despite treatment with IV ampicillin–sulbactam...He was started on induction therapy with ATRA at 45mg/m 2 /day in 2 divided doses, systemic chemotherapy with 4 doses of idarubicin (12mg/m 2 on day 1,3,5,7), followed by arsenic trioxide (ATO) on day 8 at 0.15 mg/kg IV daily until hematological response. He received a brief course of cytoreductive therapy with hydroxyurea 1500 mg twice daily during the initial phase of treatment for high-risk APLv (white cell count >10 × 10⁹/l)...He was managed as differentiation syndrome with dexamethasone and symptomatic improvement within 24 hours of initiation of steroid therapy...2010; 115(25):5137-5146) based consolidation regimen was chosen with addition of cytarabine combined with ATRA and idarubicin in the 1 st and 3 rd consolidation cycles for a total of 3 monthly cycles. BM biopsy at cell count recovery with platelets (> 100x10 9 /L) and neutrophils (> 1x10 9 /L) post-induction showed complete remission with a morphologic response (<5% blasts) and normal cytogenetic analysis. Despite the achievement of complete morphologic remission, there were concerns for the relative refractoriness of the APLv to ATO+ATRA alone, although scant with fewer data on ATO sensitivity. Thus, a chemotherapy-based consolidation approach was chosen vs ATRA+ATO alone.