65-year-old woman referred to the ED for fever and alterations in the CBC: hemoglobin 11.4 g/dL, leukocytes 0.86 x103/μL,(neutrophils 41.9 %, lymphocytes 55.8 %),platelets 48.0 x103/μL, fibrinogen 118 mg/dL,D-dimer 20.2 μg/mL. A bone marrow examination was performed and the patient was diagnosed with acute leukemia with t(15;17) in 60% of the cells. Which of the following answers is correct?
I think this is a very nice question. There is no doubt about the diagnosis. Because if you don't know the translocation, nothing happens... the answers give you the diagnosis. Now it's time to find out how acute promyelocytic leukemia is currently treated (ATRA aside... which I'm sure you know). As of 2017, the PETHEMA protocol for APL in low to intermediate risk patients (and/or over 70 years of age) is ATO+ATRA. In high risk patients, it is treated with ATRA+chemotherapy. I don't think they want you to know how risk is established in promielos, but it is based on leukocyte and platelet counts. In this case, it doesn't score anything for the score since you have <10,000 leukocytes and >40,000 platelets. That is, it is a low risk. Correct answer 2. Perhaps some people have been confused by option 3. One of the main causes of mortality in the induction of a promyelocyte is coagulopathy, but option 3 is totally incorrect. We could only mess things up even more by putting heparin!!!! I don't know what they are explaining right now in the academies, but it is clear that they wanted you to know that many promyelocytes, since 3 little years ago, are not treated with chemotherapy.
If asymptomatic, transretinoic acid (ATRA) will be initiated and controls in day hospital will be recommended.
Treatment with arsenic trioxide, ATRA and supportive therapy will be initiated.
It is a myeloblastic leukemia type M3, so chemotherapy and heparin treatment will be initiated to control disseminated intravascular coagulation.
Antibiotic treatment should be started. When the fever disappears, leukemia treatment should be started.
As of 2017, the PETHEMA protocol for APL in low to intermediate risk patients (and/or over 70 years of age) is ATO+ATRA.
One of the main causes of mortality in the induction of a promyelocyte is coagulopathy, but option 3 is totally incorrect. We could only mess things up even more by putting heparin!!!!