Simplified Treatment System Leads to Improvement in Survival Rates of Acute Promyelocytic Leukemia

Anand P. Jillella, MD

A recent study found that a combination of access to experts, a simplified treatment algorithm, and collaborative care led to substantial improvement in 1-year survival rates for acute promyelocytic leukemia (APL) patients.

Early death (ED) was cited by the researchers as the most common cause of treatment failure for APL, and in this study, the investigators suggested that access to experts in APL at academic centers as well as remote APL management guidance in community centers could lower rates of ED.

The study was led by Anand P. Jillella, MD, of the Georgia Cancer Center at Augusta University’s Division of Hematology/Oncology, and the data was presented at the American Society of Hematology (ASH) Annual Meeting and Exposition.

“The primary objective of the study was to decrease induction mortality from an estimated 30% to <15%,” Jillella and colleagues wrote. “Secondary objectives included comparing treatment outcomes between academic and community programs and to assess overall survival of enrolled patients 1 year following completion of trial accrual.”

Research and Methods

The investigators used 202 patients enrolled in 43 centers from 2017 to 2019, with the median age being 53. The team used a previous project to develop a simplified treatment algorithm for APL, using experts at 6 academic lead centers (LCs) and 293 community centers (CCs).

The new system was organized into a specific order, with patients presenting with APL to 1 of the LCs managed with input from the local expert. Meanwhile if patients presented with suspected APL, CC clinicians would reach out to 1 of the LC by email or phone.

The patients were provided with 24/7 expert support, and all patients were enrolled unless they had refused treatment or blood transfusion.

Continual communication with patients and experts was used in the first 2 weeks, due to this being the most likely period for complications.

The investigators based their therapies on standard of care with reductions in dosage for comorbidities or patient ages. Patients with more complex issues were assessed with all involved LC experts to reach an agreed upon set of recommendations.

Study Results

The investigators found that their primary endpoint was met, with the results indicating that only 7 deaths occurred, which was attributed to the induction period, and that each death was due to differentiation syndrome. Six of the deaths were in elderly patients.

The researchers did report 4 additional deaths by the first year of the trial, but they were each attributed to refusal of therapy, myocardial infarction, ovarian cancer, and COVID-19, respectively.

“Use of a simplified treatment algorithm, management recommendations provided by a limited and dedicated group of APL experts and collaborative care results in a dramatic improvement in 1-year survival,” they wrote. “Awareness among providers regarding induction mortality is an important barrier to long-term survival. Availability of a core group of APL experts to co-manage with physicians is crucial given the acuity and complexity of early disease-related mortality.”

The study, “A Simplified Patient Care Strategy to Decrease Early Deaths in Acute Promyelocytic Leukemia (APL): Results of the ECOG-ACRIN EA9131 Trial,” was presented at ASH 2022.