The Clinical Features and the Efficient Therapy of 66 Acute Promyelocytic Leukemia Patients with High Initial White Blood Cell Count.

Objective: To investigate the clinical features and the efficient therapy of acute promyelocytic leukemia(APL) with high initial white blood cell(WBC) count.

Methods: The clinical features of 66 newly diagnosed APL patients with high initial WBC and 152 patients without high initial WBC were retrospectively analyzed. Additionally, 66 patients with high WBC were divided into different groups and the therapeutic effects were compared according to the different induction therapy.

Results: The early death rate and the incidence of disseminated intravascular coagulation(DIC) and retinoic acid syndrome(RAS) were 30.3%,57.6% and 31.8% respectively for the group with initial high WBC, those were higher than the indexes of 7.2%,38.1% and 21.05% respectively for the group without initial high WBC (p <0.05),Whereas CR rate (63.6%) for the group with initial high WBC were lower than that (88.2%) for the group without initial high WBC (p <0.05). 61 of 66 patients with high WBC accepted induction therapy: 31 patients treated with all-trans retinoic acid(ATRA) alone ,21patients treated with the combination of ATRA and arsenic trioxide (ATO),9 treated with ATO alone, the early death rates were 27.3%,14.3%,55.6% respectively, CR rates were 67.7%,81.0%,44.4% respectively, the result showed there were the lowest rate of early death and the highest rate of CR in the combination group. Of 61 patients, 41 cases were given low-dose chemotherapy, the CR rate was 73.2%,total death rate was 19.5%, that of 20 patients without chemotherapy were 45.0%,55.0% respectively. The differences between two groups had statistical significance(p<0.05).

Conclusions: Compared with APL without high initial WBC, APL with high initial WBC has lower CR rate, higher early death rate, higher incidence of DIC and RAS .The combination of ATRA,ATO and chemotherapy is the most efficient therapeutic approach to APL patients with high initial WBC, which can significantly reduce the early death rate and improve the CR rate.