Management of acute promyelocytic leukemia: updated recommendations from an expert panel of the European LeukemiaNet
Management of acute promyelocytic leukemia: updated recommendations from an expert panel of the European LeukemiaNet
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DOI：
10.1182/blood-2019-01-894980
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发表时间：
2019-04-11
期刊：
影响因子：
20.3
通讯作者：
Lo-Coco, Francesco
中科院分区：
文献类型：
--
作者：
Sanz, Miguel A.;Fenaux, Pierre;Lo-Coco, Francesco
自2009年报告急性早幼粒细胞白血病（APL）管理的综合建议以来，一些研究提供了重要的见解，特别是关于三氧化二砷（ATO）在一线治疗中的作用。十年后，欧洲LeukemiaNet专家小组审查了APL在一线和复发环境中管理的最新进展，以制定关于这种疾病管理的最新循证和专家意见。除了提供目前的遗传诊断、现代风险适应性一线治疗和挽救治疗的适应症外，该综述还包含了识别和管理最重要并发症的具体建议，如出血性疾病APL分化综合征、QT间期延长和其他全反式维甲酸和ATO相关毒性，以及对治疗反应进行分子评估的建议。最后，特殊情况下的方法也进行了讨论，包括APL的儿童，老年患者和孕妇的管理。APL中最重要的挑战包括早期死亡，这仍然发生在诱导治疗之前和期间，并优化高危疾病患者的治疗。
Since the comprehensive recommendations for the management of acute promyelocytic leukemia (APL) reported in 2009, several studies have provided important insights, particularly regarding the role of arsenic trioxide (ATO) in frontline therapy. Ten years later, a European LeukemiaNet expert panel has reviewed the recent advances in the management of APL in both frontline and relapse settings in order to develop updated evidence- and expert opinion-based recommendations on the management of this disease. Together with providing current indications on genetic diagnosis, modern risk-adapted frontline therapy, and salvage treatment, the review contains specific recommendations for the identification and management of the most important complications such as the bleeding disorder APL differentiation syndrome, QT prolongation, and other all-trans retinoic acid- and ATO-related toxicities, as well as recommendations for molecular assessment of the response to treatment. Finally, the approach to special situations is also discussed, including management of APL in children, elderly patients, and pregnant women. The most important challenges remaining in APL include early death, which still occurs before and during induction therapy, and optimizing treatment in patients with high-risk disease.