Remission Criteria

These are the same as for other forms of AML. However, the distinction between normal and abnormal promyelocytes can be difficult. The PML-RARα defect can persist for some months even though the patient has entered haematological remission. The criteria for morphological complete remission is less than 5% blast cells and no hypergranular promyelocytes.

Molecular remission should be assessed after each course of chemotherapy and then on a 3-monthly basis for 2 years. Marrow samples will be collected at day 60 – following course 1 in patients requiring prolonged tretinoin (ATRA) to achieve CR. Samples will be tested by RQ-PCR for assessment of molecular remission and also sent to the Guys Lab in London by Molecular Biology. It is important to ensure this instruction and the precise details of the stage of treatment are included on the form.

Please see AML19 trial for information regarding remission criteria and treatment of high risk APML. Those who are not in molecular remission after the end of the 3rd cycle, or who regain molecular positivity, are deemed high risk and should come off the trial. The protocol suggests discussing the patient with Nigel Russell, PI for UK AML19 (9.1.3 .3). Treatment may be with arsenic or gemtuzumab and stem cell transplantation.

Anti-fungal Prophylaxis

There is some evidence that azoles are not required in APML as the period of neutropenia is short.


About this Canterbury DHB document (4369):
Document Owner:	Blake Hsu (see Who's Who)
Last Reviewed:	October 2018
Next Review:	October 2020
Keywords:
Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer The Haematology Department Protocols and Guidelines (the Red Book) are intended as a guide for registered health professionals to communicate guidelines and share best practices with supporting health professionals within New Zealand district health boards. They are not intended to be provided to or used as a reference for patients or non-registered health professionals. All health professionals must exercise their own clinical judgement and use pertinent clinical data when treating patients. The authors and editors of this publication have checked with sources believed to be reliable in their effort to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical science, neither the authors, editors, publisher, nor any other party who has been involved in preparing or publishing this work warrants that the information contained in it is accurate or complete in every respect. They therefore have no liability (whether in tort (including negligence) or otherwise) for any loss or damage arising out of any reliance on this information. This publication has been compiled by the staff and contractors of Canterbury District Health Board (CDHB) and as such CDHB has copyright for this book. Amendments must be authorised in accordance with the documented process. No release of part of, or all of, this publication to any other party or organisation is permissible without the prior approval of the designated document owner.
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