Table 2. Recommended supportive measures... | American Society of Hematology

Table 2.

Recommended supportive measures to minimize early death (adapted from NCCN guidelines recommendations)

Early APL management
Measures to minimize hemorrhage
Initiate ATRA at 45 mg/m² per day in divided doses immediately at suspicion of APL
Follow platelet count, PT, aPTT, fibrinogen level every 6 hours
Transfuse platelets to maintain a platelet count ≥50 × 10⁹/L
Transfuse cryoprecipitate to maintain a fibrinogen level >150 mg/dL
Consider fresh frozen plasma transfusion if PT or aPTT is elevated
Avoid any invasive procedures, including central venous catheter placement, until coagulopathy subsides
Initiate ATO promptly after genetic confirmation if using an ATRA/ATO-based induction
Measures to minimize severity of differentiation syndrome
Initiate prophylactic steroids (eg, prednisone 0.5 mg/kg) during induction if using ATRA/ATO-based induction
Standard-risk APL: initiate hydroxyurea if the WBC count rises >10 × 10⁹/L during induction
High-risk APL: include an anthracycline during induction

Early APL management
Measures to minimize hemorrhage
Initiate ATRA at 45 mg/m² per day in divided doses immediately at suspicion of APL
Follow platelet count, PT, aPTT, fibrinogen level every 6 hours
Transfuse platelets to maintain a platelet count ≥50 × 10⁹/L
Transfuse cryoprecipitate to maintain a fibrinogen level >150 mg/dL
Consider fresh frozen plasma transfusion if PT or aPTT is elevated
Avoid any invasive procedures, including central venous catheter placement, until coagulopathy subsides
Initiate ATO promptly after genetic confirmation if using an ATRA/ATO-based induction
Measures to minimize severity of differentiation syndrome
Initiate prophylactic steroids (eg, prednisone 0.5 mg/kg) during induction if using ATRA/ATO-based induction
Standard-risk APL: initiate hydroxyurea if the WBC count rises >10 × 10⁹/L during induction
High-risk APL: include an anthracycline during induction

aPTT, activated partial thromboplastin time.