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• W2318759798 abstract "Acute promyelocytic leukemia (APL), a subtype of acute myelogenous leukemia, is uniformly fatal if untreated. However, advances in treatment have markedly improved outcomes for this form of leukemia. Effective therapy is based on prompt recognition of the disease and urgent administration of all-trans retinoic acid (ATRA), a differentiating agent which leads to apoptosis of the malignant cells. National guidelines recommend immediate initiation of ATRA based treatment prior to confirmatory genetic testing. However, evidence is lacking as to whether APL treatment with ATRA is truly time sensitive. To evaluate the effect of time to ATRA treatment on 30-day mortality of patients with APL. All APL patients over a 5-year period, from 2007 to 2011, presenting to the emergency department (ED) at MD Anderson Cancer Center were identified using the International Classification of Diseases of Oncology histology code 98663. Patients with prior APL treatment or prior malignancies were excluded. Each patient's chart was reviewed for administration of ATRA. Times from symptom onset to ED triage and the first dose of ATRA were recorded. Patient charts were also reviewed for age at diagnosis, sex, year of diagnosis, white blood cell count, platelet count, and coagulation times. 30 day mortality was recorded for each patient. Eighty patients with a new diagnosis of APL as the first malignancy presented to the MD Anderson ED between 2007 and 2011, and all patients underwent treatment with ATRA. Four were excluded from analysis as time of symptoms onset was not available. The average patient age at diagnosis was 44 and 45% were male. The average times from onset of symptoms to ED triage and from ED triage to ATRA treatment were 17 days and 16.3 hours, respectively. Eighty-three percent of patients received ATRA treatment within 24 hours of ED presentation. Four patients died within 30 days, 3 from pulmonary hemorrhage and 1 from intracranial hemorrhage. When comparing patients who died within 30 days to the rest of the cohort, patients with early death had symptoms for four additional days. No additional differences were noted between the two groups. Time from symptoms onset to ED presentation was found to be associated with 30-day mortality. Strategies to detect patients at higher risk and education regarding symptoms may be of benefit, although identifying these variables would be difficult." @default.
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• W2318759798 date "2013-10-01" @default.
• W2318759798 modified "2023-09-26" @default.
• W2318759798 title "Time to Treatment and Mortality in Acute Promyelocytic Leukemia" @default.
• W2318759798 doi "https://doi.org/10.1016/j.annemergmed.2013.07.394" @default.
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