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Ann Hematol. 2017 Dec;96(12):2005-2013. doi: 10.1007/s00277-017-3130-7. Epub 2017 Sep 22.

Causes and prognostic factors for early death in patients with acute promyelocytic leukemia treated with single-agent arsenic trioxide.

Author information

1
Department of Hematology, The First Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, 150001, China.
2
Department of Central Laboratory, The First Affiliated Hospital, Harbin Medical University, Harbin, China.
3
Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Harbin Medical University, Harbin, China.
4
Department of Gastroenterology, Hainan Province Nongken Sanya Hospital, Sanya, Hainan, China.
5
Department of Neonatology, The First Affiliated Hospital, Harbin Medical University, Harbin, China.
6
Department of Hematology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China.
7
Department of Hematology, The First Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, 150001, China. lixiaoxia0515@sina.com.

Abstract

Early death (ED) is one of the most critical issues involved in the current care of patients with acute promyelocytic leukemia (APL). Factors identified as independent predictors of ED varied among published studies. We retrospectively analyzed the incidence, causes, and prognostic factors of ED in a series of 216 patients with newly diagnosed APL who received arsenic trioxide (ATO) as induction therapy. Multivariate logistic regression analysis was used to determine the association of clinical factors with overall ED, hemorrhagic ED, death within 7 days, and death within 8-30 days. In total, 35 EDs (16.2%) occurred that were caused by hemorrhage, differentiation syndrome (DS), infection, and other causes, in order of prevalence. The independent prognostic factors for overall ED and death within 8-30 days were the same and included serum creatinine level, Eastern Cooperative Oncology Group (ECOG) score, sex, and fibrinogen level. The risk factors for hemorrhagic ED and death within 7 days were similar and included serum creatinine level, ECOG score, and white blood cell count, while hemorrhagic ED was also associated with D-dimer. Our findings revealed a high rate of ED, and the causes of ED were similar to those among patients who received ATRA-based therapy. Increased creatinine level was the most powerful predictor, and an ECOG score greater than 2 was another strong prognostic factor for all four types of ED.

KEYWORDS:

Acute promyelocytic leukemia; Arsenic trioxide; Early death; Prognostic factor

PMID:
28940056
DOI:
10.1007/s00277-017-3130-7
[Indexed for MEDLINE]

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