Acute promyelocytic leukaemia: a retrospective analysis of patients treated at St. Bartholomew's Hospital 1969-1995

Seventy-two patients with acute promyelocytic leukemia (APML) were treated at St.Bartholomew's Hospital (SBH) over a 25-year period. Improvements in s upportive care and the use of more intensive chemotherapy have led to an in crease in the complete remission rate from 14 to 58%. Similarly, the median survival has increased from 3 weeks to 2 years; the median duration of rem ission, which was 7 months in 1974, has not yet been reached. There was als o a significant difference in survival from first recurrence, compared with that of patients with other subtypes of acute myeloid leukemia. RT-PCR ana lysis on bone marrow samples from 14 patients confirmed the presence of the PML/RARA fusion; 13 of the 14 patients achieved 'molecular remission' afte r therapy. The one patient who remained persistently positive experienced r ecurrence within 4 months. In seven of the eight patients in whom the disea se recurred, the translocation was identified by RT-PCR at the time of rela pse, whilst in one patient it was noted 4 months prior to morphological rec urrence. These results illustrate the improvement in prognosis that occurre d over a 25-year period in patients with APML treated at a single centre.