Does 3% FISH RARA from BMA indicate minimal residual disease?

Question

Hi doctor,

My husband was diagnosed with APL six years ago. He underwent treatment by following the pethema protocol for APL. After the consolidation phase, BMA revealed there is still seven percent of PML Rara using the fish rara test while negative on cytogenetics. His doctor proceeded to his maintenance phase two years on ATRA, Mercaptopurine, and Methotrexate.

For two years, monitoring blood counts has been within the normal range. BMA was done this year and revealed there is still three percent on FISH Rara.

Is this considered a minimal residual disease?
Or incomplete remission?
Does he need to undergo chemo again or start a new ATRA?

Kindly guide.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Sorry to hear about your husband's diagnosis. He has acute promyelocytic leukemia, and it is considered among the most favorable outcomes of leukemia.

After starting chemotherapy, complete remission includes less than five percent blasts in bone marrow aspirate, ANC more than 1500, platelets more than one lakh, extramedullary hematopoiesis absent, and molecular testing negativity.

After consolidation chemotherapy, if the cytogenetic study remains positive, then the prognosis cannot be considered good as compared to a negative cytogenetic leukemic patient after chemotherapy, and it can be considered here as minimal residual disease.

Treatment was given in the right way, along with proper chemotherapy and retinoic acid as well. But you have to discuss your case with your treating oncologist, and he will guide you further about the future treatment protocol.

I hope this helps.

Thank you.