Study on clinical features of early death in older patients with acute promyelocytic leukemia

This study aimed to analyze the baseline clinical characteristics, as well as the clinical features and risk factors of early death (ED) in older patients with acute promyelocytic leukemia (APL). A retrospective analysis was conducted on 198 consecutive older patients (age ≥ 50 years) with newly diagnosed APL who received arsenic trioxide alone as induction therapy, with 354 younger patients (age < 50 years) as controls. Ten easily obtainable clinical parameters were selected. Compared with the younger group, the older group had less fever, lower white blood cell (WBC) count, lower levels of albumin, and higher levels of creatinine upon admission. While the younger group had higher levels of aspartate aminotransferase and lower levels of fibrinogen (all P < 0.05). The ED rate was significantly higher in the older group (21.7% vs. 12.4%; P = 0.004). The causes of ED in the older group were bleeding, infection, embolism, differentiation syndrome, and others, in order of incidence. The cumulative incidence of ED due to infection (P = 0.0003) and embolism (P = 0.034) was significantly higher in the older group. For the older patients, independent risk factors for ED were WBC count > 5.9 × 10⁹ /L, albumin < 35.85 g/L, creatinine > 72.9 µmol/L and fibrinogen < 1.137 g/L; independent risk factor for bleeding ED was WBC count > 6.2 × 10⁹ /L; while independent risk factors for infection ED were albumin < 36.55 g/L and fibrinogen < 1.035 g/L. The baseline clinical characteristics, the clinical features and risk factors of ED in older APL patients were all quite different from those in younger patients, so research specifically targeting older patients with APL is very necessary.