APL منخفض/متوسط الخطورة (WBC ≤10,000/ml): ماذا نفعل عندما يفشل العلاج الإنقاذي في استعادة الهدأة الجزيئية

References

DOI: 10.3389/fonc.2022.1062524

1. In the era of ATRA, APL has been stratified into three categories of risk with regards to relapse-free survival (RFS): WBC >10,000/ml (high-risk), WBC ≤10,000 ml with platelet count ≤40,000/ml (intermediate-risk), and WBC ≤10,000/ml with platelet count >40,000/ml (low-risk).
2. Today, most clinicians will categorize APL within two categories, high risk (>10,000/ml) and low/intermediate risk.
3. In summary, ATO-based induction with consolidation either with autologous or allogeneic SCT for patients with MRD negativity or positivity, respectively, remains the recommended treatment for patients in first relapse, with extended ATO consolidation and GO as a single or combination agent remaining a reasonable option for patients who cannot or prefer not to undergo SCT.
4. PCR-positivity for PML-RARa at the time of autologous SCT appears to be a strong predictor of post-transplant relapse; allogeneic SCT is therefore a reasonable consideration in those patients unable to reach a complete molecular response ahead of planned transplantation.