Academic community partnership in acute promyelocytic leukemia and early mortality

Acute promyelocytic leukemia (APL) is an acute illness that presents with cytopenia, infections, and disseminated intravascular coagulation. Due to acute presentation, comorbidities, the rarity of APL, and clinician inexperience, death rates in the first month have been as high as 30%. In the nonrandomized ECOG-ACRIN EA9131 trial at 6 APL expert centers and 293 community centers, a treatment algorithm that focussed on supportive care was used to prevent early death in patients with APL. When a patient presented with APL, and expert was contacted, and a consensus treatment plan was developed using the algorithm and expert suggestions.Among 201 patients, 1-month mortality was reduced to 3%. The authors conclude that the use of a standardized algorithm with expert support decreases early deaths in acute promyelocytic leukemia.