Treatment of AML in Acute Promyelocytic Leukemia with WBC ≤10 ×10&sup9;/L (Non-High-Risk)
This protocol covers acute myeloid leukemia presenting as acute promyelocytic leukemia (APL) in the non-high-risk group — defined by a white blood cell count of 10 ×10&sup9;/L or less at diagnosis. Risk stratification by WBC directly determines the induction approach.
Clinical scenario
Acute promyelocytic leukemia (APL) with WBC ≤10 ×10&sup9;/L at presentation, meeting the non-high-risk threshold. This WBC criterion is the defining stratifier separating non-high-risk from high-risk APL.
Treatment goal
Achievement of complete remission (CR) or complete remission with incomplete haematologic recovery (CRi) by day 28, or by day 60 if not reached at the first assessment.
Non-high-risk APL is treated with an induction combination of arsenic trioxide (ATO) and ATRA, given continuously with close monitoring. Prophylactic supportive measures are incorporated from the outset to manage a recognised complication of this regimen. The complete protocol — timing, monitoring milestones, and the thresholds that trigger supportive therapy — is available in the full regimen below.
References
- Non-high-risk APL patients defined by a WBC count ≤10 ×10&sup9;/l should be treated with ATO and ATRA (Figure 4 and supplementary Table S6, available at Annals of Oncology online) [I, A].
- Non-high-risk patients continuously receive ATO/ATRA until day 28, or up to day 60 if no CR/CRi is achieved by day 28.
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