Manejo de la leucemia promielocítica aguda en recaída

Abstract

Acute promyelocytic leukaemia has become the most manageable form of myeloid leukaemia, with significantly high survival rates, however approximately one tenth of patients experience a relapse, which is why it is important to know the first-line therapeutic background for the accurate choice of an optimal early therapeutic strategy. Several factors are considered in the choice of therapeutic intervention such as risk stratification based on leukocyte count, remission time, comorbidities, mutations and APL variants that influence prognosis and overall survival. Quarterly monitoring within the first three years after first remission is crucial as this is a period of high susceptibility to relapse. Initial therapeutic selection is the determining factor in achieving complete disease remission and preventing relapse. In the latter, additional administration of anthracyclines and gemtuzumab-ozogamicin to transretinoic acid therapy with arsenic trioxide ensures the first phase of treatment, autologous haematopoietic stem cell transplantation in the consolidation phase, and allogeneic transplantation is used as a second alternative to the latter. Autologous transplantation and arsenic trioxide play a key role in relapse therapy, their efficacy leading to higher disease-free survival rates and lower mortality rates.