Extramedullary Relapse Of Acute Promyelocytic Leukemia Research Articles

Extramedullary relapse in lumbar spine of a patient with acute promyelocytic leukemia after remission for 16 years: case report and literature review

A 46-years female patients with extramedullary relapse of lumbar spine after 16-year remission of acute promyelocytic leukemia (APL) was reported. After surgical treatment, local radiotherapy combined with all-trans retinoic acid (ATRA) and arsenic trioxide (ATO), the patient achieved and maintained a second complete remission (CR). The literature showed that extramedullary relapse was a relatively rare complication of APL. The recurrence time of APL after remission varied from 6 months to 12 years, and the central nervous system was the most frequent site of relapse. The causes and treatment for extramedullary relapse of APL are various. The successful diagnosis and treatment of this case may provide experience for management of extramedullary relapse in APL patients. Key words: Leukemia, myelocgtic, acute; Recurrence

Enhanced adhesion/migration and induction of Pyk2 expression in K562 cells following imatinib exposure

Concern about extramedullary relapse (EMR) despite favorable response in the bone marrow has been raised with the use of imatinib for treatment of chronic myeloid leukemia (CML). In the present study we show an increase in adhesion, migration and invasion capabilities of the CML cell line K562 following imatinib administration. Imatinib induced upregulation of Pyk2 mRNA and protein levels. Pyk2 inhibition resulted in a reduction of K562 cells' adhesion and migration subsequent to imatinib treatment. This effect was similar to that shown by us previously with all trans retinoic acid (ATRA) in the acute promyelocytic leukemia (APL) cell line NB4. Our data pinpoint Pyk2 as a shared key mediator of targeted-therapy induced adhesion and migration and may implicate that targeting Pyk2 may serve as an effective therapeutic strategy to reduce EMR in APL and CML.

Extramedullary relapse in acute promyelocytic leukemia treated with all-trans retinoic acid and chemotherapy

We analyzed the incidence, presenting features, risk factors of extramedullary (EM) relapse occurring in acute promyelocytic leukemia (APL) treated with all-trans retinoic acid (ATRA) and chemotherapy by using a competing-risk method. In total, 740/ 806 (92%) patients included in three multicenter trials (APL91, APL93 trials and PETHEMA 96) achieved CR, of whom 169 (23%) relapsed, including 10 EM relapses. Nine relapses involved the central nervous system (CNS) and one the skin, of which two were isolated EM relapse. In patients with EM disease, median WBC count was 26950/mm3 (7700-162000). The 3-year cumulative incidence of EM disease at first relapse was 5.0%. Univariate analysis identified age <45 years (P=0.05), bcr3 PML-RARalpha isoform (P= 0.0003) and high WBC counts (> or = 10,000/ mm3) (P<0.0001) as risk factors for EM relapse. In multivariate analysis, only high WBC count remained significant (P= 0.001). Patients with EM relapse had a poorer outcome since median survival from EM relapse was 6.7 months as compared to 26.3 months for isolated BM relapse (P=0.04). In conclusion, EM relapse in APL occurs more frequently in patients with increased WBC counts (> or = 10,000/mm3) and carries a poor prognosis. Whether CNS prophylaxis should be systematically performed in patients with WBC > or = 10,000/mm3 at diagnosis remains to be established.

Extramedullary relapse in a patient with acute promyelocytic leukemia: successful treatment with arsenic trioxide, all- trans retinoic acid and gemtuzumab ozogamicin therapies

Acute promyelocytic leukemia (APL) is characterized by the presence of the t(15;17) translocation, resulting in the PML-RAR fusion protein. Standard treatment consists of the combination of all- trans retinoic acid (ATRA) with an anthracycline that results in complete remission (CR) rates in excess of 90%. Recently, several new agents have been shown to have clinical activity in APL. These include a liposomal formulation of ATRA (lipo-ATRA), and gemtuzumab ozogamicin (GO). Herein, we report a patient with APL who relapsed with extramedullary disease 2.5 years after lipo-ATRA therapy and was successfully treated with the sequence of A 2O 3, ATRA, and GO and we summarize our experience with patients with isolated extramedullary relapse in APL.