ابيضاض الدم الحاد الصدري (APL) عالي الخطورة — المحدد بعدد كريات الدم البيضاء أعلى من 10 ×10⁹/l — هو مجموعة فرعية سريرية متميزة تتطلب استراتيجية علاجية محددة. ينطبق هذا البروتوكول عندما لا يحقق خط العلاج السابق في هذا السياق هجوعاً كاملاً.
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] (see supplementary Table S6, available at Annals of Oncology online).
In the AIDA regimen, the induction and consolidation treatments are followed by a 2-year maintenance phase.
If ATO is not available/affordable for first-line treatment, the classical combination of ATRA and anthracycline-based ChT is still an acceptable option, which however requires 2-year maintenance therapy with methotrexate and 6-mercaptopurine.
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