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HERO ID
2343442
Reference Type
Journal Article
Title
[Acute promyelocytic leukaemia]
Author(s)
Reikvam, H; Hovland, R; Bruserud, O
Year
2014
Is Peer Reviewed?
1
Journal
Tidsskrift for den Norske Lægeforening
ISSN:
0029-2001
EISSN:
0807-7096
Volume
134
Issue
10
Page Numbers
1052-1055
Language
nor
PMID
24865730
DOI
10.4045/tidsskr.13.1508
Abstract
BACKGROUND Acute promyelocytic leukaemia (APL) is a subtype of acute myeloid leukaemia (AML) with unique biological and clinical features and unique therapeutic requirements. The article provides a brief description of the development, pathophysiology, diagnosis and treatment of APL.METHOD The article is based on the authors' own experience and reviews of key articles and national and international guidelines.RESULTS The disease is caused by a single genetic event, namely the translocation t(15;17), which gives rise to the oncoprotein PML-RARA. Clinical and morphological characteristics arouse suspicion of the disease, and the diagnosis is verified by detecting the translocation. At the time of diagnosis most patients have severe coagulopathy and the predominant clinical manifestation is bleeding. Early mortality is due to severe haemorrhage, usually intracranial. Early treatment start with all-trans retinoic acid (ATRA) on suspicion of APL is essential to reduce this early mortality. ATRA is also an important part of continued treatment, in combination with anthracycline-based chemotherapy and possibly arsenic. After this treatment, the prognosis for disease-free long-term survival is > 90 %. There are also safe and effective treatment options for elderly patients with complex comorbidities.INTERPRETATION With APL it is particularly important to start disease-targeting therapy in the form of ATRA quickly because of the high risk of serious haemorrhages and high early mortality. If serious haemorrhages are avoided, the prognosis is very good.
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