Clinical Predictive Marker For Early Death In Acute Promyelocytic Leukemia

[Background and Objective]Acute promyelocytic leukemia(APL)is a subtype with the highest cure rate in AML with good hematological remission.Nevertheless,many researchers have observed a high incidence of early deaths.The present study aims to retrospectively investigate the clinical characteristics and analyze the impact of medical intervention on early death(ED)in patients with new diagnosed acute promyelocytic leukemia to explore the causes of early death and identify the potential risk factors for ED,to enrich objective evidence for clinical decisions.[Methods]1.Collected a total of 146 newly diagnosed hospitalized patients with APL in Fujian Medical University Union Hospital from January 2017 to December 2019 and divided them into early death group and non early death group.2.Recorded the basic information(including age,gender,the time from onset to visit,whether there are concomitant disease)、laboratory examination results(including blood routine,coagulation function,biochemical indexes,whether met DIC diagnostic criteria on admission,maximum leukocyte count and its peak time during induction therapy、total time of WBC≥10×10~9/L、PLT<20×10~9/L and PT prolonged more than 3s and(or)APTT prolonged more than 10s、minimum plasma fibrinogen level and duration of FIB<1.5g/L)、fusion gene type、gene mutation type、other chromosome variants and additional chromosome karyotypes as well as medical intervention measures(including whether to use cytotoxic drugs,cytotoxic drug type,accumulated and per unit body surface area dose of anthracycline,total time of agranulocytosis after induction therapy,transfusion volume of plasma,cryoprecipitate,fibrin and platelet,whether to use glucocorticoid);3.Analyzed the clinical features of patients with early death and the potential risk factors leading to death.4.Applyed chi square t test and nonparametric test to univariate analysis according to the data type,and the parameters with P<0.05were analyzed with multivariate binary logistic stepwise regression analysis.[Result]The early mortality of 146 newly diagnosed APL patients in our hospital was11.64%(17/146)while the median age of the ED group was up to 43.53 years(13-77years)with a ratio of men to women was 11∶6.The death cases were composed of 7cases of cerebral hemorrhage(41.18%),1 case of pulmonary hemorrhage(5.89%),5cases of severe pneumonia(29.41%),1 case of bloodstream infection(5.89%),2 cases of differentiation syndrome(11.76%)and 1 case of acute left heart failure(5.89%).Thus,Cerebral hemorrhage is the main cause of early death in APL.The univariate analysis showed that these two groups differed significantly by number of case with WBC≥10×10~9/L、PLT count、LDH level、presence of DIC on admission、maximum leukocyte count and its peak time、accumulated time of PT prolongation≥3s and(or)APTT prolongation≥10s,plasma transfusion volume and glucocorticoid use.While the multivariate analysis revealed that WBC≥10×10~9/L、higher WBC peak counts and higher LDH level were independent risk factors for early death of APL.[Conclusion]The early mortality rate of 146 newly diagnosed APL patients in our hospital is 11.64%with a main cause:cerebral hemorrhage.Besides,higher LDH were the independent risk factors for early death of APL.