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Influence of initiation time and white blood cell count on the efficacy of cytotoxic agents in acute promyelocytic leukemia during induction treatment

  • Authors:
    • Fang Xu
    • Chang-Xin Yin
    • Chun-Li Wang
    • Bing-Jie Ding
    • Qing-Xiu Zhong
    • Xue-Jie Jiang
    • Ling Jiang
    • Zhi-Xiang Wang
    • Fan-Yi Meng

  • View Affiliations

  • Published online on: July 2, 2018     https://doi.org/10.3892/br.2018.1120
  • Pages: 227-232
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Abstract

The present study retrospectively analyzed 96 newly diagnosed acute promyelocytic leukemia (APL) patients with low-intermediate mortality risk to identify the optimum timing to initiate cytotoxic chemotherapy following all-trans retinoic acid (ATRA) administration. Based on white blood cell (WBC) at chemotherapy initiation, the patients were divided into three groups: low WBC (WBC count ≤4x109/l), intermediate WBC (WBC count >4x109/l and <15x109/l) and high WBC group (WBC count ≥15x109/l). According to the period from ATRA commencement to chemotherapy, 96 patients were further divided into two groups: ≤3 days group (chemotherapy within 3 days of ATRA) and >3 days group (chemotherapy >3 days after ATRA). Clinical effects were compared by univariate analysis and multivariate analyses. The incidence rate of differentiation syndrome (DS; also termed retinoic acid syndrome) was 0.0, 11.1 and 40.0% in the low, intermediate and high WBC groups, respectively (P<0.001); complete remission (CR) rate was 90.5, 100.0 and 73.3%, respectively (P<0.001); and the rate of early mortality (defined as fatality during induction treatment) was 4.8, 0.0 and 26.7%, respectively (P<0.001). No differences were identified in clinicolaboratory parameters between the ≤3 days and >3 days groups, except in time to achieve CR (P=0.004) and rate of bleeding related to chemotherapy (P=0.009), both being higher in the >3 days group. Multivariate analyses indicated WBC count at chemotherapy was the only independent risk factor for the occurrence of DS [P=0.002; odds ratio (OR) =1.058, 95% confidence interval (CI) =1.021-1.095] and early mortality (P=0.036; OR =1.036, 95% CI =1.002-1.070). For newly diagnosed APL patients with low-intermediate risk, chemotherapy initiation should be recommended until WBC count rises to between 4x109/l and 15x109/l during induction treatment.
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September-2018
Volume 9 Issue 3

Print ISSN: 2049-9434
Online ISSN:2049-9442

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  • CiteScore: 3.7
  • CiteScore Rank: Q2: #23/79 Pharmacology, Toxicology and Pharmaceutics
  • Source Normalized Impact per Paper (SNIP): 0.742
  • SCImago Journal Rank (SJR): 0.488
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Spandidos Publications style
Xu F, Yin C, Wang C, Ding B, Zhong Q, Jiang X, Jiang L, Wang Z and Meng F: Influence of initiation time and white blood cell count on the efficacy of cytotoxic agents in acute promyelocytic leukemia during induction treatment. Biomed Rep 9: 227-232, 2018
APA
Xu, F., Yin, C., Wang, C., Ding, B., Zhong, Q., Jiang, X. ... Meng, F. (2018). Influence of initiation time and white blood cell count on the efficacy of cytotoxic agents in acute promyelocytic leukemia during induction treatment. Biomedical Reports, 9, 227-232. https://doi.org/10.3892/br.2018.1120
MLA
Xu, F., Yin, C., Wang, C., Ding, B., Zhong, Q., Jiang, X., Jiang, L., Wang, Z., Meng, F."Influence of initiation time and white blood cell count on the efficacy of cytotoxic agents in acute promyelocytic leukemia during induction treatment". Biomedical Reports 9.3 (2018): 227-232.
Chicago
Xu, F., Yin, C., Wang, C., Ding, B., Zhong, Q., Jiang, X., Jiang, L., Wang, Z., Meng, F."Influence of initiation time and white blood cell count on the efficacy of cytotoxic agents in acute promyelocytic leukemia during induction treatment". Biomedical Reports 9, no. 3 (2018): 227-232. https://doi.org/10.3892/br.2018.1120