ORIGINAL RESEARCH article
Front. Med.
Sec. Hematology
Risk factors associated with early death, disease relapse and second primary malignancies (SPMs) in patients with newly diagnosed acute promyelocytic leukemia
Dong-Ming Zhou
Jie He
Min Zhou
Qian Zhang
Lan-Xin Chen
Cui-Ying Yuan
Bing Chen
Hui Zeng
Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
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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.
Summary
Keywords
Acute promyelocytic leukemia, CNS prophylaxis, early death, relapse, risk stratification, second primary malignancy, Treatment Era
Received
23 July 2025
Accepted
20 January 2026
Copyright
© 2026 Zhou, He, Zhou, Zhang, Chen, Yuan, Chen and Zeng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Bing Chen; Hui Zeng
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