Risk stratification for early mortality in newly diagnosed acute promyelocytic leukemia: a multicenter, non-selected, retrospective cohort study

作者：Suhyeon Kim, Jiye Jung, Seo-Yeon Ahn, Mihee Kim, So Yeon Jeon, Chang‐Hoon Lee, Dae Sik Kim, Se Ryeon Lee, Hwa Jung Sung, Chul Won Choi, Byung‐Soo Kim, Hyeoung‐Joon Kim, Jae‐Yong Kwak, Yong Park, Jae‐Sook Ahn, Ho‐Young Yhim · 发表于：Frontiers in Oncology · 年份：2024 · DOI：10.3389/fonc.2024.1307315 · 被引用次数：3 · 研究领域：Retinoids in leukemia and cellular processes、Pregnancy and preeclampsia studies、Acute Myeloid Leukemia Research

Introduction Despite the current effective treatments for acute promyelocytic leukemia (APL), early mortality (EM), defined as death within 30 days of presentation, is a major hurdle to long-term survival. Methods We performed a multicenter retrospective study to evaluate the incidence and clinical characteristics of EM in patients with newly diagnosed APL and to develop a risk stratification model to predict EM. Results We identified 313 eligible patients diagnosed between 2000 and 2021 from five academic hospitals. The median age was 50 years (range 19-94), and 250 (79.9%) patients were <65 years. Most patients (n=274, 87.5%) received their first dose of all-trans retinoic acid (ATRA) within 24 hours of presentation. EM occurred in 41 patients, with a cumulative incidence of 13.1%. The most common cause of EM was intracranial hemorrhage (n=22, 53.6%), and most EMs (31/41, 75.6%) occurred within the first seven days of APL presentation. In a multivariable analysis, we identified three independent factors predicting EM: age ≥65 years (HR, 2.56), white blood cell count ≥8.0 x 10 9 /L (HR, 3.30), and ATRA administration >24 hours of presentation (HR, 2.95). Based on these factors, patients were stratified into three categories with a significantly increasing risk of EM: 4.1% for low risk (54.3%; no risk factors; HR 1), 18.5% for intermediate risk (34.5%; 1 factor; HR 4.81), and 40.5% for high risk (11.2%; 2-3 factors; HR 13.16). Discussion The risk of EM is still ...