A recent study found that a combination of expert access, simplified treatment algorithms, and co-treatment significantly improved 1-year survival of acute promyelocytic promyelocytic patients. leukemia (APL) patient.
Early death (ED) was cited by researchers as the most common cause of treatment failure in APL. In this study, researchers suggested that access to his APL specialist at academic centers and remote APL management guidance at community centers may be reduced. Percentage of ED.
The study was led by Anand P. Jillella, MD, Georgia Cancer Center, Department of Hematology/Oncology, University of Augusta, and data presented at the American Society of Hematology (ASH) Annual Meeting and Exposition .
“The primary goal of this study was to reduce the induction mortality from an estimated 30% to less than 15%,” write Jillella and colleagues. “Secondary objectives included comparing treatment outcomes between academic and community programs, and assessing overall survival in enrolled patients before she assessed one year later. .”
Research and methods
Investigators used 202 patients enrolled at 43 centers from 2017 to 2019, with a median age of 53 years. Using previous projects, the team developed a simplified treatment algorithm for APL using experts from 6 Academic Lead Centers (LCs) and 293 community centers. (CC).
The new system was organized in a specific order and patients presented APL to one of the LCs managed with information from local experts. On the other hand, if a patient suspects her APL, the CC clinician will contact one of the LCs by email or phone.
Patients were provided with 24/7 expert support and all patients were enrolled unless they refused treatment or blood transfusions.
Continuous communication with patients and specialists was used during the first 2 weeks, as this is the period with the highest chance of complications.
Investigators based treatment on standard therapy with reduced doses based on comorbidities or patient age. Patients with more complex problems were evaluated with all relevant LC specialists and agreed on a set of recommendations.
Survey results
The researchers found that the primary endpoint was met, resulting in only 7 deaths attributable to the induction phase, each of which was shown to be due to a differentiation syndrome. Six of the deaths were elderly patients.
The researchers reported four more deaths by the first year of the trial, attributed to treatment refusal, myocardial infarction, ovarian cancer, and COVID-19, respectively.
“Simplified treatment algorithms, management recommendations provided by a limited dedicated APL expert group, and the use of co-treatment dramatically improve one-year survival,” they wrote. I’m here. “Healthcare provider awareness of induction mortality is an important barrier to long-term survival. is very important.”
The study, “A Simplified Patient Care Strategy to Reduce Early Death in Acute Promyelocytic Leukemia (APL): Results from the ECOG-ACRIN EA9131 Trial,” was presented at ASH 2022.
