PMID- 36611025 OWN - NLM STAT- MEDLINE DCOM- 20230117 LR - 20230117 IS - 1471-2407 (Electronic) IS - 1471-2407 (Linking) VI - 23 IP - 1 DP - 2023 Jan 7 TI - Effects of peripheral blood leukocyte count and tumor necrosis factor-alpha on early death in acute promyelocytic leukemia. PG - 27 LID - 10.1186/s12885-022-10499-2 [doi] LID - 27 AB - BACKGROUND: Early death remains a major factor in survival in APL. We aimed to analyze the risk factors for differentiation syndrome and early death in acute promyelocytic leukemia (APL). METHODS: The clinical data of APL patients who were newly diagnosed at Mianyang Central Hospital from January 2013 to January 2022 were retrospectively analyzed. RESULTS: Eighty-six newly diagnosed APL patients (37 males and 49 females) were included in this study. The median age was 46 (17-75) years. Sixty-one patients (70.9%) had low/intermediate-risk APL, and 25 patients (29.1%) had high-risk APL. The incidence of differentiation syndrome (DS) was 62.4%. The multivariate analysis showed that a peak white blood cell (WBC) count >/=16 x 10;9/L was an independent risk factor (OR = 11.000, 95% CI: 2.830-42.756, P = 0.001) for DS in all APL patients, while a WBC count >/=10 x 10;9/L on Day 5 was an independent risk factor for DS in low-intermediate risk APL patients (OR = 9.114, 95% CI: 2.384-34.849, P = 0.001). There were 31 patients (36.5%) with mild DS and 22 patients (25.9%) with severe DS. The multivariate analysis showed that WBC count >/=23 x 10;9/L at chemotherapy was an independent risk factor for severe DS (OR = 10.500, 95% CI: 2.344-47.034, P = 0.002). The rate of early death (ED) was 24.4% (21/86). The multivariate analysis showed that male gender (OR = 7.578,95% CI:1.136-50.551, P = 0.036), HGB < 65 g/L (OR = 16.271,95% CI:2.012-131.594, P = 0.009) and WBC count >/=7 x 10;9/L on Day 3(OR = 23.359,95% CI:1.825-298.959, P = 0.015) were independent risk factors for ED. The WBC count at diagnosis, WBC count on Day 3 and WBC count on Day 5 had moderate positive correlations with tumor necrosis factor-alpha (TNF-alpha) at diagnosis, and the correlation coefficients were 0.648 (P = 0.012), 0.615 (P = 0.033), and 0.609 (P = 0.035), respectively. The WBC count had no correlation with IL-6. CONCLUSION: During induction treatment, cytotoxic chemotherapy may need to be initiated to reduce the risk of DS for APL patients with a low-intermediate risk WBC count >/=10 x 10;9/L on Day 5 or for all patients with a peak WBC count >/=16 x 10;9/L. Patients with WBC > 7 x 10;9/L on Day 3 have a higher risk of ED. Leukocyte proliferation is associated with TNF-alpha rather than IL-6, and TNF-alpha may be a potential biomarker for predicting ED. CI - (c) 2023. The Author(s). FAU - Wen, Jingjing AU - Wen J AD - Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No 12. Changjia alley, Jingzhong Street, Fucheng district, Mianyang, 621000, China. FAU - Xu, Fang AU - Xu F AD - Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No 12. Changjia alley, Jingzhong Street, Fucheng district, Mianyang, 621000, China. 147377807@qq.com. FAU - Zhou, Qiaolin AU - Zhou Q AD - Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No 12. Changjia alley, Jingzhong Street, Fucheng district, Mianyang, 621000, China. FAU - Shi, Lin AU - Shi L AD - Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No 12. Changjia alley, Jingzhong Street, Fucheng district, Mianyang, 621000, China. FAU - Liu, Yiping AU - Liu Y AD - Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No 12. Changjia alley, Jingzhong Street, Fucheng district, Mianyang, 621000, China. FAU - Yue, Jing AU - Yue J AD - Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No 12. Changjia alley, Jingzhong Street, Fucheng district, Mianyang, 621000, China. FAU - Zhang, Ya AU - Zhang Y AD - Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No 12. Changjia alley, Jingzhong Street, Fucheng district, Mianyang, 621000, China. FAU - Liang, Xiaogong AU - Liang X AD - Department of Hematology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No 12. Changjia alley, Jingzhong Street, Fucheng district, Mianyang, 621000, China. LA - eng PT - Journal Article DEP - 20230107 PL - England TA - BMC Cancer JT - BMC cancer JID - 100967800 RN - 0 (Interleukin-6) RN - 5688UTC01R (Tretinoin) RN - 0 (Tumor Necrosis Factor-alpha) SB - IM MH - Female MH - Humans MH - Male MH - Middle Aged MH - Antineoplastic Combined Chemotherapy Protocols/therapeutic use MH - Interleukin-6 MH - *Leukemia, Myeloid, Acute/drug therapy MH - *Leukemia, Promyelocytic, Acute/diagnosis MH - Leukocyte Count MH - Leukocytes/pathology MH - *Leukopenia/chemically induced MH - Retrospective Studies MH - Syndrome MH - *Thrombocytopenia/chemically induced MH - Tretinoin MH - Tumor Necrosis Factor-alpha MH - Adolescent MH - Young Adult MH - Adult MH - Aged PMC - PMC9824944 OTO - NOTNLM OT - Cell differentiation OT - Leukemia, promyelocytic, acute OT - Leukocyte count OT - Mortality OT - Prognosis OT - Tumor necrosis factor-alpha COIS- The authors certify that they have no conflicts of interest to disclose in the subject matter discussed in this paper. EDAT- 2023/01/08 06:00 MHDA- 2023/01/11 06:00 PMCR- 2023/01/07 CRDT- 2023/01/07 23:13 PHST- 2022/05/13 00:00 [received] PHST- 2022/12/30 00:00 [accepted] PHST- 2023/01/07 23:13 [entrez] PHST- 2023/01/08 06:00 [pubmed] PHST- 2023/01/11 06:00 [medline] PHST- 2023/01/07 00:00 [pmc-release] AID - 10.1186/s12885-022-10499-2 [pii] AID - 10499 [pii] AID - 10.1186/s12885-022-10499-2 [doi] PST - epublish SO - BMC Cancer. 2023 Jan 7;23(1):27. doi: 10.1186/s12885-022-10499-2.