TY - JOUR
T1 - Comanagement strategy between academic institutions and community practices to reduce induction mortality in acute promyelocytic leukemia
AU - Jillella, Anand P.
AU - Arellano, Martha L.
AU - Gaddh, Manila
AU - Langston, Amy A.
AU - Heffner, Leonard T.
AU - Winton, Elliott F.
AU - McLemore, Morgan L.
AU - Zhang, Chao
AU - Caprara, Catherine R.
AU - Simon, Kathryn S.
AU - Bolds, Sheldon L.
AU - DeBragga, Stephanie
AU - Karkhanis, Prachi
AU - Krishnamurthy, Shruthi H.
AU - Tongol, Jose
AU - El Geneidy, Mohamed M.
AU - Pati, Asim
AU - Gerber, Jonathan M.
AU - Grunwald, Michael R.
AU - Cortes, Jorge
AU - Bashey, Asad
AU - Stuart, Robert K.
AU - Kota, Vamsi K.
N1 - Publisher Copyright:
© 2020 by American Society of Clinical Oncology.
PY - 2021
Y1 - 2021
N2 - PURPOSE Acute promyelocytic leukemia (APL) is a curable leukemia with . 90% survival in clinical trials. Population-based studies from Sweden and US SEER data have shown long-term survival rates of 62% and 65.7%, with the lower rate being from a higher percentage of early deaths. METHODS In this prospective, multicenter trial, we developed a simplified algorithm that focused on prevention and early treatment of the three main causes of death: bleeding, differentiation syndrome, and infection. All patients with a diagnosis of APL were included. The initial 6 months were spent educating oncologists about early deaths in APL. At the time of suspicion of an APL, an expert was contacted. The algorithm was made available followed by discussion of the treatment plan. Communication between expert and treating physician was frequent in the first 2 weeks, during which time most deaths take place. RESULTS Between September 2013 and April 2016, 120 patients enrolled in the study from 32 hospitals. The median age was 52.5 years, with 39% . 60 years and 25% with an age-adjusted Charlson comorbidity index . 4. Sixty-three percent of patients were managed at community centers. Two patients did not meet the criteria for analysis, and of 118 evaluable patients, 10 died, with an early mortality rate of 8.5%. With a median follow-up of 27.3 months, the overall survival was 84.5%. CONCLUSION Induction mortality can be decreased and population-wide survival improved in APL with the use of standardized treatment guidelines. Support from experts who have more experience with induction therapy is crucial and helps to improve the outcomes.
AB - PURPOSE Acute promyelocytic leukemia (APL) is a curable leukemia with . 90% survival in clinical trials. Population-based studies from Sweden and US SEER data have shown long-term survival rates of 62% and 65.7%, with the lower rate being from a higher percentage of early deaths. METHODS In this prospective, multicenter trial, we developed a simplified algorithm that focused on prevention and early treatment of the three main causes of death: bleeding, differentiation syndrome, and infection. All patients with a diagnosis of APL were included. The initial 6 months were spent educating oncologists about early deaths in APL. At the time of suspicion of an APL, an expert was contacted. The algorithm was made available followed by discussion of the treatment plan. Communication between expert and treating physician was frequent in the first 2 weeks, during which time most deaths take place. RESULTS Between September 2013 and April 2016, 120 patients enrolled in the study from 32 hospitals. The median age was 52.5 years, with 39% . 60 years and 25% with an age-adjusted Charlson comorbidity index . 4. Sixty-three percent of patients were managed at community centers. Two patients did not meet the criteria for analysis, and of 118 evaluable patients, 10 died, with an early mortality rate of 8.5%. With a median follow-up of 27.3 months, the overall survival was 84.5%. CONCLUSION Induction mortality can be decreased and population-wide survival improved in APL with the use of standardized treatment guidelines. Support from experts who have more experience with induction therapy is crucial and helps to improve the outcomes.
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U2 - 10.1200/OP.20.00395
DO - 10.1200/OP.20.00395
M3 - Article
C2 - 33125295
AN - SCOPUS:85104276069
SN - 2688-1527
VL - 17
SP - E497-E505
JO - JCO Oncology Practice
JF - JCO Oncology Practice
IS - 4
ER -