Recommended supportive measures to minimize early death (adapted from NCCN guidelines recommendations)
| Early APL management . |
|---|
| Measures to minimize hemorrhage |
| Initiate ATRA at 45 mg/m2 per day in divided doses immediately at suspicion of APL |
| Follow platelet count, PT, aPTT, fibrinogen level every 6 hours |
| Transfuse platelets to maintain a platelet count ≥50 × 109/L |
| Transfuse cryoprecipitate to maintain a fibrinogen level >150 mg/dL |
| Consider fresh frozen plasma transfusion if PT or aPTT is elevated |
| Avoid any invasive procedures, including central venous catheter placement, until coagulopathy subsides |
| Initiate ATO promptly after genetic confirmation if using an ATRA/ATO-based induction |
| Measures to minimize severity of differentiation syndrome |
| Initiate prophylactic steroids (eg, prednisone 0.5 mg/kg) during induction if using ATRA/ATO-based induction |
| Standard-risk APL: initiate hydroxyurea if the WBC count rises >10 × 109/L during induction |
| High-risk APL: include an anthracycline during induction |
| Early APL management . |
|---|
| Measures to minimize hemorrhage |
| Initiate ATRA at 45 mg/m2 per day in divided doses immediately at suspicion of APL |
| Follow platelet count, PT, aPTT, fibrinogen level every 6 hours |
| Transfuse platelets to maintain a platelet count ≥50 × 109/L |
| Transfuse cryoprecipitate to maintain a fibrinogen level >150 mg/dL |
| Consider fresh frozen plasma transfusion if PT or aPTT is elevated |
| Avoid any invasive procedures, including central venous catheter placement, until coagulopathy subsides |
| Initiate ATO promptly after genetic confirmation if using an ATRA/ATO-based induction |
| Measures to minimize severity of differentiation syndrome |
| Initiate prophylactic steroids (eg, prednisone 0.5 mg/kg) during induction if using ATRA/ATO-based induction |
| Standard-risk APL: initiate hydroxyurea if the WBC count rises >10 × 109/L during induction |
| High-risk APL: include an anthracycline during induction |
aPTT, activated partial thromboplastin time.