Analysis Of Factors Related To Early Death In Acute Promyelocytic Leukemia

Background:Acute promyelocytic leukemia(APL)is a special subtype of acute promyeloid leukemia(AML).It is distinguished from other AML types by the characteristics of t(15;17)(q22;q21),formed PML-RARα fusion gene is the driver gene of APL pathogenesis.With the in-depth understanding of the pathogenesis of APL and the introduction of efficient treatment targeting the fusion protein that drives the disease,APL has transformed from a cancer with high fatality rate into a highly curable cancer.The complete response rate of patients under initial treatment has reached 90%to 95%,and the overall survival and progression-free survival of patients have been greatly improved,with the long-term survival rate exceeding 90%.Is one of the greatest and most inspiring successes in hematologic oncology.However,the incidence of early death(ED)in clinical APL patients is still as high as 5%-29%.How to reduce the occurrence of ED is the key to improve the cure rate,and is also the problem that clinicians have been paying attention to.Objective:The purpose of this study was to retrospectively analyze the clinical data of newly diagnosed patients with acute promyelocytic leukemia in the Department of Hematology,the Second Affiliated Hospital of Anhui Medical University,so as to identify the risk factors leading to early death as early as possible,provide evidence for appropriate intervention as early as possible,and improve the prognosis of APL patients to the greatest extent.Methods:The basic information,routine laboratory examination,bone marrow examination and other clinical medical records of 84 newly diagnosed patients with acute promyelocytic leukemia diagnosed and treated in the Department of Hematology,the Second Affiliated Hospital of Anhui Medical University from October 2008 to June 2022 were retrospectively analyzed.The quantitative data were stratified by the cut-off value obtained by ROC curve.Logistic stepwise regression analysis was used to explore the high risk clinical factors affecting early death in newly diagnosed APL patients.Results:1.In the past 14 years,84 patients with acute promyelocytic leukemia were newly diagnosed in our hospital.The median age of onset was 43.5 years old,and the gender distribution was 39 males and 45 females.Among them,9 cases died early,with an early mortality rate of 10.7%.2.The onset age of the early death group was significantly higher than that of the non-early death group.The main clinical manifestations on admission were gingival bleeding and lung infection.The causes of early death were intracranial hemorrhage(56%),lung infection(33%)and differentiation syndrome(11%),respectively.3.Unifactorial analysis suggested that age of onset≥64.5 years,stratified prognosis as high risk,DIC at initial diagnosis,prothrombin time≥16.6s,and percentage of promyelocytic granulocyte in peripheral blood smear≥86.5%were risk factors associated with early death at initial diagnosis of APL.After constructing multi-factor Logistic regression model analysis,it is concluded that:Age of onset>64.5 years(OR=83.90,95%CI 4.45-1582.02,P=0.003)and percentage of peripheral blood smear promyelocytic granulocyte ≥86.5%(OR=24.00,95%CI 1.95-294.91,P=0.013)were associated with a higher risk of ED.It was statistically significant.Conclusion:Age of onset≥64.5 years and percentage of promyelocytic granulocyte in peripheral blood smear≥86.5%were independent risk factors for early death of APL at initial diagnosis.