Analysis Of The Risk Factors Of Early Death In Acute Promyelocytic Leukemia

[Background and Objective] Acute promyelocytic leukemia(APL)is a unique subtype of acute myeloid leukemia(AML), which accounting for 10%~15% of AML cases. The clinical prognosis of APL previously considered poor because it often combined with bleeding and coagulation dysfunction. However, with the development of molecular pathogenesis, APL has become the most curable form of AML due to the introduction of all-trans retinoic acid(ATRA) and arsenic trioxide(ATO). Despite the advance in APL treatment, early death(ED)(Deaths occurred within 30 days after admission) remains a problem with reported ED rates ranging from 10% to 30%, which threatens the long-term survival of APL patients. Given that ED is important for long-term survival of APL patients, the aim of this study is to explore the clinical characteristics and risk factors of early death in newly diagnosed APL patients.[Method] Clinical data of 123 patients with newly diagnosed APL in our hospital were analyzed retrospectively during January 2013 to January 2016. The collecting data was analyzed with t-test, x2-check, Fisher’s exact probability and multivariate Logistic regression analysis.[Result] Among the 123 patients, 24 cases developed early death and the early death rate was 19.51%. There were 12 men and 12 women in the study group, the median age of patients was 47(range 4~70) years. Causes of ED included CNS bleeding in 13(54.17%) patients, pulmonary bleeding in 1(4.17%), differentiation syndrome in 5(20.83%), infection in 3(12.50%), heart failure in 1(4.17%) and multi-organ failure in 1(4.17%). Univariate analysis showed that age, Sanz high risk, high blast count in peripheral blood, high level of lactate dehydrogenase, the peak level of WBC(≥20×109/L), the peak time of WBC(<7.5days), DIC, low fibrinogen, the minimum of fibrinogen, FAB M3 b and FLT3-ITD mutation were assosciated with ED in APL. In a forword stepwise multiple logistic regression analysis, age>60, Sanz high risk, high blast count in peripheral blood and high level of lactate dehydrogenase were independent risk factors of early death.[Conclusion] The early death rate of APL in our hospital was 19.5%. We show hemorrhagic death especially CNS bleeding may be the major cause of death. Age>60, Sanz high risk, high blast count in peripheral blood and high level of lactate dehydrogenase were independent risk factors of early death.