ORIGINAL RESEARCH article
Front. Med.
Sec. Hematology
Risk Factors and Management Strategies in Acute Promyelocytic Leukemia: A Real-World Single-Center Retrospective Study
Yafeng Jiang 1
Haiying Zhong 1
Wang Huihui 1
Doudou Tang 2
Mingjie Chen 3
Hongling Peng 1
Guangsen Zhang 1
Yewei Wang 1
1. Department of Hematology, Second Xiangya Hospital, Central South University, Changsha, China
2. Department of Respiratory Medicine, Hunan Province Chest Hospital, Changsha, China
3. Bio-Tech Shanghai Co Ltd, Shanghai, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Abstract
Background: Acute promyelocytic leukemia (APL) has become a highly curable malignancy with the advent of targeted therapies. However, early death (ED), predominantly caused by severe hemorrhagic complications, continues to be the most significant obstacle to achieving high survival rates in real-world clinical practice, where outcomes often lag behind those reported in controlled trials. Aims: This retrospective study aimed to identify the key clinical and laboratory factors associated with ED and overall survival (OS) in a cohort of newly diagnosed APL patients. The study also sought to evaluate the impact of current supportive care strategies and identify opportunities for improved management. Methods: This single-center, retrospective analysis included 132 patients newly diagnosed with APL between June 2017 and January 2023. Data on demographics, baseline laboratory values, immunophenotyping, treatment, and outcomes were collected. Univariate and multivariate logistic regression analyses were used to identify independent predictors of ED, while Kaplan-Meier and Cox regression models were used to assess survival outcomes. Results: The ED rate was 12.88% (17 patients), with hemorrhage being the primary cause. Multivariate analysis identified three independent risk factors for ED: a high white blood cell (WBC) count (>20×10⁹/L), prolonged prothrombin time (PT), and CD2 positivity. While severe thrombocytopenia was common, it was not an independent predictor, likely due to an aggressive platelet transfusion policy. Elevated lactate dehydrogenase (LDH) levels were significantly associated with poorer OS. 3 Furthermore, all relapses in the high-risk group involved the central nervous system (CNS). Conclusions: This study found that high initial WBC count, prolonged PT, and CD2 positivity are critical independent predictors of ED in APL. The findings underscore the necessity of prompt diagnosis, risk-adapted therapy, and comprehensive multidisciplinary care, including aggressive management of coagulopathy. Enhanced CNS prophylaxis should be considered for high-risk patients to prevent relapse.
Summary
Keywords
Acute promyelocytic leukemia (APL), CD2 expression, early death, Hyperleukocytosis, prognostic factors
Received
24 November 2025
Accepted
17 February 2026
Copyright
© 2026 Jiang, Zhong, Huihui, Tang, Chen, Peng, Zhang and Wang. 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: Yewei Wang
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.