Suggested guidelines for supportive care measures and initial approach to patients with APL
| Guideline . | Summary . |
|---|---|
| 1 | Institute ATRA without delay at first suspicion of the diagnosis without waiting for cytogenetic or molecular genetic confirmation. |
| 2 | Check CBC and DIC screens 3 or 4 times a day to maintain platelet count more than 30 000 to 50,000/μL and fibrinogen more than 150 mg/dL with transfusions of platelets and cryoprecipitate several times a day to maintain these levels. |
| 3 | Avoid leukapheresis. |
| 4 | Avoid routine lumbar puncture. |
| 5 | Avoid placement of central venous catheter. |
| 6 | Be vigilant in diagnosing APL differentiation syndrome; if present, administer dexamethasone 10 mg/m2 per day until complete resolution of the signs and symptoms. Resume ATRA or ATO (if it had been stopped) under the coverage of corticosteroids. |
| 7 | Avoid myeloid growth factors in induction. |
| 8 | Give dexamethasone for high-risk patients with leukocytosis with WBC more than or equal to 30 000-50 000/μL. |
| 9 | Do not obtain a bone marrow aspirate and biopsy at the nadir during induction. |
| Guideline . | Summary . |
|---|---|
| 1 | Institute ATRA without delay at first suspicion of the diagnosis without waiting for cytogenetic or molecular genetic confirmation. |
| 2 | Check CBC and DIC screens 3 or 4 times a day to maintain platelet count more than 30 000 to 50,000/μL and fibrinogen more than 150 mg/dL with transfusions of platelets and cryoprecipitate several times a day to maintain these levels. |
| 3 | Avoid leukapheresis. |
| 4 | Avoid routine lumbar puncture. |
| 5 | Avoid placement of central venous catheter. |
| 6 | Be vigilant in diagnosing APL differentiation syndrome; if present, administer dexamethasone 10 mg/m2 per day until complete resolution of the signs and symptoms. Resume ATRA or ATO (if it had been stopped) under the coverage of corticosteroids. |
| 7 | Avoid myeloid growth factors in induction. |
| 8 | Give dexamethasone for high-risk patients with leukocytosis with WBC more than or equal to 30 000-50 000/μL. |
| 9 | Do not obtain a bone marrow aspirate and biopsy at the nadir during induction. |