Other than WBC count, what are prognostic indicators for acute promyelocytic leukemia (APL)?

Updated: May 03, 2019
  • Author: Sandy D Kotiah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Molecular and immunophenotypic features associated with a higher risk of relapse include expression in APL blasts of the stem/progenitor cell antigen CD34, the neural adhesion molecule (CD56), and the T cell antigen CD2. Often, the expression of these markers is associated with a high WBC count. [15]

Since the early 1990s, there have been reports of extramedullary relapse to the skin and central nervous system with APL that are associated with a poor prognosis.

A retrospective analysis examined the outcome of 155 patients with the microgranular variant (M3V) of APL who were treated with ATRA-based therapy in three clinical trials. The analysis revealed no difference in incidence of complications, survival, and response compared with patients who had classical M3 morphology, when outcomes were adjusted for the WBC count or the relapse risk score. [16]

A long-term observational study of 1025 patients with APL in first complete remission found that therapy-related myeloid neoplasms (t-MNs) are a rare but severe complication. Therapy for APL in these patients consisted of ATRA plus anthracycline chemotherapy. Further research is needed to determine how to decrease the frequency of t-MN following ATRA plus anthracycline-based therapy. [17]


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