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CC BY-NC-ND 4.0 · South Asian J Cancer 2023; 12(03): 274-279
DOI: 10.1055/s-0042-1757303
Original Article
Hematological Malignancies

Complications during Induction Chemotherapy in Acute Promyelocytic Leukemia: An Institutional Experience

Rajani Priya Yedla 
1   Department of Medical Oncology, Mahatma Gandhi Cancer Hopsital and Research Institute, Visakhapatnam, Andhra Pradesh, India
,
Stalin Chowdary Bala 
2   Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
,
Venkateswara Rao Pydi
2   Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
,
Rachana Chennamaneni 
2   Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
,
Siva Prasad Kuruva
2   Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
,
Meher Lakshmi Konatam
2   Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
,
Sadashivudu Gundeti
2   Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Abstract

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Stalin Chowdary Bala

Introduction Acute promyelocytic leukemia (APL) has transformed from a highly fatal disease to a highly curable one. Induction deaths continue to represent one of the major impediments in modern therapy of APL. Sepsis, hemorrhage, and differentiation syndrome are the major complications during induction therapy in APL. The present study reports the incidence and prognostic factors of major complications during induction chemotherapy in patients with newly diagnosed APL.

Materials and Methods The present study was a single institutional, observational, retrospective study. All cases of APL diagnosed by morphology and confirmed by RT PCR (PML RARα) were included in this study. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 25.

Results A total of 73 patients were analyzed. The median age at presentation was 30 years (range, 3–60 years) with a female to male ratio of 1.02:1. The most common symptom at presentation was fever (80%), followed by fatigue (56%) and gum bleeding (37%). The majority of the patients at presentation were high risk (42.4%), followed by intermediate risk (38.4%) and low risk (19.2%). Fifty-seven (78%) patients achieved complete hematological remission and 16 (22%) succumbed during induction chemotherapy. Infection was the most common cause of induction death (50%), followed by hemorrhage (37.5%) and differentiation syndrome (12.5%). On univariate analysis of prognostic factors, bcr3 variant, grade 3/4 bleeding during induction, and low levels of albumin at presentation were significant for induction mortality (p = 0.034, 0.041, and 0.008 respectively). On multivariate analysis, only serum albumin < 3.5 g/dL was an independent predictor for induction mortality (p = 0.043).

Conclusion The majority of patients were high risk at presentation. Sepsis was the most common complication during induction and also the leading cause of induction death. Identifying induction complications at the earliest and providing aggressive supportive measures can further improve outcomes in APL.

Keywords

acute promyelocytic leukemia - febrile neutropenia - differentiation syndrome - bleeding - induction complications

Note

This study was orally presented at ISMPOCON 2018 in October 2018 in Jaipur.




Publication History

Article published online:
02 November 2022

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