Factors associated with early death in patients with acute promyelocytic leukemia after induction chemotherapy

Introduction: Acute promyelocytic leukemia (APL) is a phenotypic and pathological distinct variant of acute myeloid leukemia represents as a medical emergency attributed to a high rate of mortality following induction treatment.The aim of this study is to assess clinical and paraclinical parameters associated with early death in patients with APL.Methods: This retrospective study enrolled newly diagnosed APL patients admitted in the hematology and oncology wards of Namazi Hospital (Shiraz, Iran) from April 2014 to March 2018.The hospital archives of all patients who met the inclusion criterion were examined, and the following data were extracted: age, gender, ethnicity, comorbidities, white blood cell (WBC), hemoglobin and platelet count at the admission, the blood transfusion protocol (restrictive vs. liberal) and the patient's outcome in the first 30 days of hospitalization (survival or death).Results: This study consisted of 41 patients with APL including 23 men and 18 women with mean ages and standard deviations of 37.8 ± 12.1 and 35 ± 11.3 for men and women, respectively.In this study, 33 patients (80.4%) survived the induction therapy.Multivariate analysis showed WBC count more than 20 (×10 9 /L) (adjusted odds ratio: 1.34 with 95% confidence interval of 1.15-1.57),receive of liberal transfusion (1.25, 1.11-1.42),platelet count lower than 40 (×10 9 /L) (1.25, 1.10-1.41)and being older (1.008, 1.002-1.014)increased the odds of early death in patients with APL.Conclusion: Our study showed that being older, having higher WBC count and lower platelet count at the admission and receive of liberal blood transfusion were associated with higher early death and there is a need for strategies to reduce early death in these high-risk patients.