Canterbury DHB

Context

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:

Ruth Spearing (see Who's Who)

Issue Date:

October 2018

Next Review:

October 2020

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 4369