Successful treatment of high-risk acute promyelocytic leukemia in very elderly patients using all-trans retinoic acid plus reduced-dose idarubicin

摘要

The introduction of all-trans retinoic acid (ATRA) therapy has markedly improved the outcome for younger patients with acute promyelocytic leukemia (APL) [1, 2]; however, the optimal treatment regimen for elderly APL patients remains unclear because few patients over 70 years of age are included in clinical trials [3]. Here, we report the successful use of ATRA plus reduced-dose idarubicin to treat nonagenarian high-risk APL patients. Patient 1 (Fig. la), a 91-year-old woman with a previous history of hypertension and cerebral infarction, was admitted to our hospital with fever and bleeding. Her Eastern Cooperative Oncology Group Performance Status (ECOG-PS) was 4. Laboratory results were as follows: hemoglobin (Hb), 103 g/1; white blood cell (WBC) count, 36.2x109/1; platelet (Plt) count, 51x109/1; serum lactate dehydrogenase (LDH), 1,437 IU/1; prothrombin time-international normalized ratio (PT-INR), 1.41; activated partial thromboplastin time (APTT), 34.5 s; fibrinogen, 157 mg/dl; and D-dimer, 315.7 ug/dl.