Can we induce a 100% CR rate in newly diagnosed APL?
So, with accumulating experience, the next question is whether CR can be obtained in almost all newly diagnosed patients with APL. The answer will probably be no. In multicenter studies, there are about 5–10% early deaths within 1 month after the start of ATRA treatment with or without chemotherapy.5,6,7,8,9,10,11,12,13,14,15,17 The cause of death is mainly intracranial bleeding. Even in individuals without APL, intracranial bleeding occurs more frequently in elderly people. Thus, elderly APL patients would be more prone to intracranial bleeding. Among 369 consecutively registered, newly diagnosed APL patients in the JALSG APL92 study, only one out of 72 patients of age <30 years failed to achieve CR, while six (32%) out of 19 patients of age 70 years failed to do so chiefly due to early death by hemorrhaging in the cranium or other sites such as the lungs.15 Younger patients can generally overcome the APL-associated coagulopathy, but not elderly patients.Whether there is an intrinsic
