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Article: Characteristics and predictors of early hospital deaths in newly diagnosed APL: a 13-year population-wide study

TitleCharacteristics and predictors of early hospital deaths in newly diagnosed APL: a 13-year population-wide study
Authors
Issue Date2021
PublisherAmerican Society of Hematology: OAJ. The Journal's web site is located at http://www.bloodadvances.org/
Citation
Blood Advances, 2021, v. 5 n. 14, p. 2829-2838 How to Cite?
AbstractDespite therapeutic advances, early death (ED) remains a major factor curtailing survival of acute promyelocytic leukemia (APL). Studies examining factors that cause early death (ED; within 30 days of admission) and the correlation of survival with the timing of administration of all-trans retinoic acid (ATRA) and hemostatic parameters are scarce. We performed a cohort analysis of nonselect patients with newly diagnosed APL who presented to the health care system in Hong Kong, where oral arsenic trioxide was used. From 1 January 2007 to 30 April 2020, 358 patients (median age, 47 [1-97] years) with newly diagnosed APL were identified. ED occurred in 56 patients (16%): 11 (3%) died in the first 2 days after admission (intracranial hemorrhage [ICH], n = 6; APL-differentiation syndrome [APL-DS], n = 4; infection, n = 1); 22 (6%) died within 3 to 7 days (ICH, n = 12; APL-DS, n = 8; infections, n = 2), and 23 (6%) died within 8 to 30 days (ICH, n = 7; APL-DS, n = 11; infection, n = 5). Factors significantly associated with ED by multivariate analysis included male sex (P = .01); presenting leukocyte count ≥10 × 109/L (P = .03); fibrinogen <1.5 g/L (P = .02); and ATRA administration >24 hours after hospital admission (P < .001). After a median follow-up of 47 (0-166) months, the 5- and 10-year overall survival (OS) was 68.6% and 61.2%, respectively. Excluding EDs, the 5- and 10-year post–30-day OS improved to 81.3% and 72.5%. Early administration of ATRA (<24 hours) and vigorous correction of hemostatic abnormalities, including hypofibrinogenemia, are key to reducing ED.
Persistent Identifierhttp://hdl.handle.net/10722/301398
ISSN
2023 Impact Factor: 7.4
2023 SCImago Journal Rankings: 3.065
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorSingh, H-
dc.contributor.authorYung, Y-
dc.contributor.authorChu, HT-
dc.contributor.authorAu, WY-
dc.contributor.authorYip, PK-
dc.contributor.authorLee, E-
dc.contributor.authorYim, R-
dc.contributor.authorLEE, P-
dc.contributor.authorCheuk, D-
dc.contributor.authorHa, SY-
dc.contributor.authorLeung, RYY-
dc.contributor.authorMa, ESK-
dc.contributor.authorKumana, CR-
dc.contributor.authorKwong, YL-
dc.date.accessioned2021-07-27T08:10:28Z-
dc.date.available2021-07-27T08:10:28Z-
dc.date.issued2021-
dc.identifier.citationBlood Advances, 2021, v. 5 n. 14, p. 2829-2838-
dc.identifier.issn2473-9529-
dc.identifier.urihttp://hdl.handle.net/10722/301398-
dc.description.abstractDespite therapeutic advances, early death (ED) remains a major factor curtailing survival of acute promyelocytic leukemia (APL). Studies examining factors that cause early death (ED; within 30 days of admission) and the correlation of survival with the timing of administration of all-trans retinoic acid (ATRA) and hemostatic parameters are scarce. We performed a cohort analysis of nonselect patients with newly diagnosed APL who presented to the health care system in Hong Kong, where oral arsenic trioxide was used. From 1 January 2007 to 30 April 2020, 358 patients (median age, 47 [1-97] years) with newly diagnosed APL were identified. ED occurred in 56 patients (16%): 11 (3%) died in the first 2 days after admission (intracranial hemorrhage [ICH], n = 6; APL-differentiation syndrome [APL-DS], n = 4; infection, n = 1); 22 (6%) died within 3 to 7 days (ICH, n = 12; APL-DS, n = 8; infections, n = 2), and 23 (6%) died within 8 to 30 days (ICH, n = 7; APL-DS, n = 11; infection, n = 5). Factors significantly associated with ED by multivariate analysis included male sex (P = .01); presenting leukocyte count ≥10 × 109/L (P = .03); fibrinogen <1.5 g/L (P = .02); and ATRA administration >24 hours after hospital admission (P < .001). After a median follow-up of 47 (0-166) months, the 5- and 10-year overall survival (OS) was 68.6% and 61.2%, respectively. Excluding EDs, the 5- and 10-year post–30-day OS improved to 81.3% and 72.5%. Early administration of ATRA (<24 hours) and vigorous correction of hemostatic abnormalities, including hypofibrinogenemia, are key to reducing ED.-
dc.languageeng-
dc.publisherAmerican Society of Hematology: OAJ. The Journal's web site is located at http://www.bloodadvances.org/-
dc.relation.ispartofBlood Advances-
dc.titleCharacteristics and predictors of early hospital deaths in newly diagnosed APL: a 13-year population-wide study-
dc.typeArticle-
dc.identifier.emailSingh, H: gillhsh@hku.hk-
dc.identifier.emailYim, R: ritayim@hku.hk-
dc.identifier.emailCheuk, D: klcheuk@hkucc.hku.hk-
dc.identifier.emailHa, SY: syha@hku.hk-
dc.identifier.emailMa, ESK: eskma@hku.hk-
dc.identifier.emailKwong, YL: ylkwong@hkucc.hku.hk-
dc.identifier.authoritySingh, H=rp01914-
dc.identifier.authorityKwong, YL=rp00358-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1182/bloodadvances.2021004789-
dc.identifier.pmid34269798-
dc.identifier.scopuseid_2-s2.0-85111199820-
dc.identifier.hkuros323680-
dc.identifier.volume5-
dc.identifier.issue14-
dc.identifier.spage2829-
dc.identifier.epage2838-
dc.identifier.isiWOS:000679400100005-
dc.publisher.placeUnited States-

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