Meeting report

Abstract

Despite successful treatment with all- trans retinoic acid and chemotherapy, life-threatening bleeding remains a challenging complication of acute promyelocytic leukemia (APL). Indeed, bleeding and thrombosis are major complications of APL that lead to early death in approximately 10% of patients despite the success of current treatment. This condition may be attributed, in part, to the diffuse activation of coagulation, hyperfibrinolysis, and non-specific proteolytic activity that is observed in patients with APL. Therapeutic agents that induce the differentiation of leukemia cells improve outcomes compared with those observed using chemotherapy alone. They also correct the hyperactivity of the coagulation and fibrinolytic systems, thereby reducing early death from bleeding. Prophylactic therapy with newer anticoagulants may prove beneficial in patients with APL, but this must be confirmed in well-designed, randomized, controlled trials. A workshop was convened 21 January 2004 in London, England, to discuss the clinical and biological aspects of the APL-associated coagulopathy and the application of recent findings to the management of patients with APL. Eight speakers participated in the workshop: Benjamin Brenner (M.D.), Hematology Institute, Rambam Medical Center, Haifa, Israel; Anna Falanga (M.D.), Ospedali Ruiniti di Bergamo, Bergamo, Italy; Hau C. Kwaan (M.D.), Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Howard Liebman (M.D.), University of Southern California, Cancer Center, Los Angeles, CA, USA; Emmanuel Raffoux (M.D.), Department of Hematology, Hôpital Saint Louis, Paris, France; Frederick R. Rickles (M.D., F.A.C.P.), The George Washington School of Medicine, Washington, DC, USA; Javier de la Serna (M.D., Ph.D.), Servicio de Hematologia, Hospital Universitario 12 de Octubre, Madrid, Spain; and Martin S. Tallman (M.D.), Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. This meeting report provides synopses of their presentations and a summary of highlights from the meeting.