PMID- 34269798
OWN - NLM
STAT- MEDLINE
DCOM- 20210723
LR  - 20210925
IS  - 2473-9537 (Electronic)
IS  - 2473-9529 (Print)
IS  - 2473-9529 (Linking)
VI  - 5
IP  - 14
DP  - 2021 Jul 27
TI  - Characteristics and predictors of early hospital deaths in newly diagnosed APL: a 
      13-year population-wide study.
PG  - 2829-2838
LID - 10.1182/bloodadvances.2021004789 [doi]
AB  - Despite therapeutic advances, early death (ED) remains a major factor curtailing 
      survival of acute promyelocytic leukemia (APL). Studies examining factors that 
      cause early death (ED; within 30 days of admission) and the correlation of 
      survival with the timing of administration of all-trans retinoic acid (ATRA) and 
      hemostatic parameters are scarce. We performed a cohort analysis of nonselect 
      patients with newly diagnosed APL who presented to the health care system in Hong 
      Kong, where oral arsenic trioxide was used. From 1 January 2007 to 30 April 2020, 
      358 patients (median age, 47 [1-97] years) with newly diagnosed APL were 
      identified. ED occurred in 56 patients (16%): 11 (3%) died in the first 2 days 
      after admission (intracranial hemorrhage [ICH], n = 6; APL-differentiation 
      syndrome [APL-DS], n = 4; infection, n = 1); 22 (6%) died within 3 to 7 days 
      (ICH, n = 12; APL-DS, n = 8; infections, n = 2), and 23 (6%) died within 8 to 30 
      days (ICH, n = 7; APL-DS, n = 11; infection, n = 5). Factors significantly 
      associated with ED by multivariate analysis included male sex (P = .01); 
      presenting leukocyte count >/=10 x 109/L (P = .03); fibrinogen <1.5 g/L (P = .02); 
      and ATRA administration >24 hours after hospital admission (P < .001). After a 
      median follow-up of 47 (0-166) months, the 5- and 10-year overall survival (OS) 
      was 68.6% and 61.2%, respectively. Excluding EDs, the 5- and 10-year post-30-day 
      OS improved to 81.3% and 72.5%. Early administration of ATRA (<24 hours) and 
      vigorous correction of hemostatic abnormalities, including hypofibrinogenemia, 
      are key to reducing ED.
CI  - (c) 2021 by The American Society of Hematology.
FAU - Gill, Harinder
AU  - Gill H
AUID- ORCID: 0000-0002-9551-4893
AD  - Department of Medicine, The University of Hong Kong, Hong Kong SAR, China.
FAU - Yung, Yammy
AU  - Yung Y
AD  - Department of Medicine, The University of Hong Kong, Hong Kong SAR, China.
FAU - Chu, Hiu-Tung
AU  - Chu HT
AD  - Department of Medicine, The University of Hong Kong, Hong Kong SAR, China.
FAU - Au, Wing-Yan
AU  - Au WY
AD  - Blood-Med Clinic, Central, Hong Kong SAR, China.
FAU - Yip, Pui-Kwan
AU  - Yip PK
AD  - Department of Medicine, The University of Hong Kong, Hong Kong SAR, China.
FAU - Lee, Emily
AU  - Lee E
AD  - Department of Medicine, The University of Hong Kong, Hong Kong SAR, China.
FAU - Yim, Rita
AU  - Yim R
AUID- ORCID: 0000-0002-1754-1247
AD  - Department of Medicine, The University of Hong Kong, Hong Kong SAR, China.
FAU - Lee, Paul
AU  - Lee P
AUID- ORCID: 0000-0002-4149-0435
AD  - Department of Medicine, The University of Hong Kong, Hong Kong SAR, China.
FAU - Cheuk, Daniel
AU  - Cheuk D
AD  - Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, 
      Hong Kong SAR, China.
FAU - Ha, Shau-Yin
AU  - Ha SY
AD  - Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, 
      Hong Kong SAR, China.
FAU - Leung, Rock Y Y
AU  - Leung RYY
AD  - Division of Haematology and Blood Bank, Department of Pathology and Clinical 
      Biochemistry, Queen Mary Hospital, Hong Kong SAR, China; and.
FAU - Ma, Edmond S K
AU  - Ma ESK
AUID- ORCID: 0000-0002-1259-2205
AD  - Department of Pathology, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China.
FAU - Kumana, Cyrus R
AU  - Kumana CR
AD  - Department of Medicine, The University of Hong Kong, Hong Kong SAR, China.
FAU - Kwong, Yok-Lam
AU  - Kwong YL
AD  - Department of Medicine, The University of Hong Kong, Hong Kong SAR, China.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Blood Adv
JT  - Blood advances
JID - 101698425
RN  - 5688UTC01R (Tretinoin)
RN  - S7V92P67HO (Arsenic Trioxide)
SB  - IM
MH  - Arsenic Trioxide
MH  - Hospitals
MH  - Humans
MH  - *Leukemia, Promyelocytic, Acute/diagnosis/drug therapy
MH  - Leukocyte Count
MH  - Male
MH  - Middle Aged
MH  - Tretinoin
PMC - PMC8341351
EDAT- 2021/07/17 06:00
MHDA- 2021/07/24 06:00
PMCR- 2021/07/16
CRDT- 2021/07/16 12:26
PHST- 2021/03/19 00:00 [received]
PHST- 2021/05/03 00:00 [accepted]
PHST- 2021/07/16 12:26 [entrez]
PHST- 2021/07/17 06:00 [pubmed]
PHST- 2021/07/24 06:00 [medline]
PHST- 2021/07/16 00:00 [pmc-release]
AID - S2473-9529(21)00370-0 [pii]
AID - 2021/ADV2021004789 [pii]
AID - 10.1182/bloodadvances.2021004789 [doi]
PST - ppublish
SO  - Blood Adv. 2021 Jul 27;5(14):2829-2838. doi: 10.1182/bloodadvances.2021004789.