1 APL is a highly curable disease in ATRA/ATO era ATO+ATRA+CT PML - - PowerPoint PPT Presentation

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1 APL is a highly curable disease in ATRA/ATO era ATO+ATRA+CT PML - - PowerPoint PPT Presentation

Sep 12, 2023 20 likes •225 views

1 APL is a highly curable disease in ATRA/ATO era ATO+ATRA+CT PML ATO Apoptosis ATRA+CT RARa ATRA Differentiation CT Chen SJ, et al. Blood 2011;117:6425 Coagulation abnormalities is fatal for APL t(15;17) DIC PML/RARa DNR+Ara-C

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APL is a highly curable disease in ATRA/ATO era

Chen SJ, et al. Blood 2011;117:6425

PML RARa

Differentiation Apoptosis

ATRA ATO

ATRA+CT ATO+ATRA+CT CT

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Coagulation abnormalities is fatal for APL

t(15;17)

PML/RARa

DIC DNR+Ara-C I Cunningham, et al. Blood 1989 ;73:1116 促凝 颗粒

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Early death is 5-30% and majorly caused by hemorrhage

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Incidence of Bleeding

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Incidence of Thrombosis

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The mechanism of coagulation abnormality in APL

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Question

  • Whether oral arsenic and ATRA

can ameliorate coagulopathy in APL?

  • Is there any difference of impact on

coagulopathy between oral vs iv. arsenic

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Purpose

  • to evaluate the impact of oral arsenic (the

realgar-indigo naturalis formula, RIF) + ATRA on coagulopathy in APL compared with intravenous ATO+ATRA during induction.

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Methods

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Hong-Hu Zhu , et al. JCO 2013; 31：4215 Mitoxantron 2-4mg,d 4-8

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Results

  • Period: 2007-2012
  • 83 patients in our center(45 oral, 38 IV.)
  • Hemostasis analysis during induction

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Diagnostic Criteria of Disseminated Intravascular Coagulation

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Taylor FB, et al. Thrombosis and Haemostasis. 2001;86:1327-30 ≥

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Characteristics of APL patients

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Comparison of the dynamic changes of hemostatic parameters between the RIF and ATO groups

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Comparison of the dynamic changes of hemostatic parameters in DIC Score=4

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Platelet kinetics in DIC score=4

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Platelet kinetics in DIC score=4

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Conclusion

  • RIF +ATRA therapy ameliorate coagulopathy

rapidly in APL patients

  • RIF shows a significant beneficial effect in

accelerating the recovery of thrombocytopenia and hypofibrinogenemia for subclinical DIC patients.

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Acknowledgements

  • All the patients involved in this study
  • My colleagues

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Thanks for your attention