Clinical Characteristics Of Early Death In Newly Treated Acute Promyelocytic Leukemia

Objective:With the application of all-trans retinoic acid(ATRA)and arsenic in the treatment of acute promyelocytic leukemia(APL),the complete remission rate and overall survival rate of APL have increased significantly,which made it a curable leukemia tape.But the early death of APL has not decreased.The purpose of this study was to explore the clinical features of patients with early death of APL and analyze their related risk factors,so as to reduce the early death(ED)of APLMethods:1.86 cases of APL patients treated in the Second Affiliated Hospital of Kunming Medical University from January 2007 to December 2019 were collected,and they were divide into early death group and non-early death group.2.The basic information of two groups was record,including age,gender,clinical manifestations,signs,and relevant examinations at admission,including blood routine,coagulation function,biochemistry,bone marrow cytology,fusion genes,flow immunotyping,chromosomes,mutant genes,changes in blood routine and coagulation function during the course of the disease,complications,and treatment options.The differences of the above clinical data between the early death group and the non-early death group were compared,and the risk factors of early death were analyzed.3.The clinical characteristics of patients with early death and discuss the causes of death was analyzed.4.Data analysis according to the data type,chi-square test was used for qualitative data,t test was used for normal distribution data of quantitative variable data,rank sum test was used for non-normal distribution data,and binary logistic regression method was used for multivariate analysisResults:1.Among 86 newly treated APL patients,18 cases of early death occurred,and the early death rate was 20.93%.There were 13 males and 5 females,with a median age of 47 years(20-88 years).The causes of early death:11 patient died of hemorrhagic death(61.11%),including 8 cases of intracranial hemorrhage and 3 cases of intrapulonary hemorrhage,3 patient died of pulmonary infection(16.67%),2 patient died of retinoic acid syndrome(DS)(11.10%),1 patient died of acute renal failure(5.56%),and 1 patient died of multiple organ failure(MODS)(5.56%).Eleven patient(61.11%)died within the first week,two patient(11.10%)died within the second week,and five patient(27.78%)died after two weeks.2.The univariate analysis showed that the risk factors for early death may be:white blood cell≥10×109/L,low serum albumin,high lactate dehydrogenase(LDH),and the presence of DIC.Multivariate binary logistic regression analysis showed that white blood cell≥10×109/L,low serum albumin,and the presence of DIC were independent risk factors for early death.Conclusion:The early death rate of APL in our hospital was 20.93%.The causes of death included:bleeding(intracranial hemorrhage and pulmonary hemorrhage),pulmonary infection,DS,acute renal failure,and multiple organ failure.The most common cause of death was intracranial hemorrhage.white blood cell≥10×109/L,low serum albumin,and the presence of DIC were independent risk factors for early death.