Risk factors associated with early death, disease relapse and second primary malignancies (SPMs) in patients with newly diagnosed acute promyelocytic leukemia

Abstract

Early death (ED), relapse, and second primary malignancies (SPMs) remain major barriers to both early and long-term outcomes in acute promyelocytic leukemia (APL). We retrospectively analyzed 174 consecutive patients with newly diagnosed APL treated at a single center, with a median follow-up of 59 months. ED occurred in 9 patients, relapse in 7 patients, and SPMs in 7 patients. We evaluated clinical, laboratory, and treatment-related factors associated with these outcomes, including comparisons across treatment eras and regimen categories, and we summarized institutional practice regarding central nervous system (CNS) prophylaxis and management. ED clustered with severe hemorrhagic and thrombotic complications during induction. Relapse was associated with subsequent adverse outcomes, including SPMs and death. Given the low number of events, multivariable modeling was restricted and interpreted cautiously with penalized approaches used as sensitivity analyses where applicable. The findings support the risk-adapted approach emphasizing prompt initiation of ATRA and intensified supportive care in patients with high-risk baseline features, alongside vigilant molecular and long-term surveillance to facilitate early detection and timely management of relapse and SPMs.