AML-436 Central Nervous Relapse Risk in Acute Promyelocytic Leukemia Diagnosed From 2018 to April 2023 in a Mexican Medical Institution

• Published in: Clinical lymphoma, myeloma and leukemia myeloma and leukemia, 2023-09, Vol.23, p.S300-S300
• Main Authors: Merida, Maria Olga, Hernandez-Ruiz, Eleazar, Alvarez-Vera, Jose Luis, Arana, Luara, De la Peña-Celaya, Jose Antonio, Montonay, Leire, Perez-Zuñiga, Juan Manuel, Pelayo, Cynthia, Espitia, Maria Eugenia, Hernandez, Karen, Nava, Lorena, Alvarado-Ibarra, Martha
• Format: Article
• Language: English
• Subjects: acute promyelocytic leukemia; AML; central nervous system relapse
• ISSN: 2152-2650; 2152-2669
• DOI: 10.1016/S2152-2650(23)01059-5

Acute promyelocytic leukemia (APL) represents about 5%–10% of acute myelogenous leukemias (AML) and it is distinguished by the presence of the translocation between chromosomes 15 and 17. The current treatment allows for complete remission in 90% of patients. The risk of relapse is around 2%-3% and central nervous system (CNS) relapse is the most common site. There are several prognostic factors for CNS relapse that have been described, these are white blood cell count above 10x109/L, high blast count on peripheral blood count above 10x109/L, clinical CNS hemorrhage during induction therapy, elevated serum lactate dehydrogenase (LDH), FLT3 mutation detection, and expression of CD56 in flow cytometry. To determine the risk factors for CNS relapse in newly diagnosed APL from 2018 to April 2023. Retrospective analysis from 2018 to April 2023. Data was retrieved from 27 patients with newly diagnosed APL in Centro Medico Nacional 20 de Noviembre in Mexico City. The population analyzed consisted of 63% (17) female and 37% (10) males; median age was 45 (19–72) years old. With the known CNS relapse risk factors, we analyzed the population obtaining that the average leukocytes at diagnosis was 10.5 (0.3–98), average blast count on peripheral blood smear was 27% (0–97), average LDH was 478 (169–1796), (normal upper range, 246). FLT3 mutation detection was performed in 59% (16) of patients; 4 patients had a positive result. Only 1 patient had a documented CNS hemorrhage, and expression of CD56 was present in 11% (3) of the flow cytometry performed. An average of 1.9 risk factors were identified in these patients, ranging from 0 to 4. With current treatments, up to 90% of patients with APL can achieve complete remission. A subset of risk factors for CNS relapse have been described. We believe that identifying these factors could lead to improvement in follow-up and close monitoring in patients considered high risk.