This protocol covers patients with acute promyelocytic leukaemia (APL) presenting with a white blood cell count above 10 ×10⁹/l — the threshold that defines high-risk disease. This elevated WBC at diagnosis is the key factor shaping treatment selection and the supportive measures required during induction.
High-risk APL is managed with combination regimens that include differentiation-based therapy alongside anthracycline-containing chemotherapy, with prophylactic supportive measures against differentiation syndrome initiated from the start of induction.
Achievement of complete remission.
APL high-risk patients defined by a WBC count >10 ×10⁹/l may be treated with either ATRA plus ATO combined with an anthracycline (while ATO is not approved for high-risk APL) or with conventional ATRA plus anthracycline-based ChT [e.g. ATRA and idarubicin (AIDA)] [II, A].
To prevent differentiation syndrome, patients should be treated prophylactically with steroids as soon as they receive ATRA (e.g. prednisolone 0.5 mg/kg/day) and with hydroxycarbamide as soon as the WBC count increases above 5–10 ×10⁹/l.
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