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Although all-trans retinoic acid (ATRA) has greatly improved the prognosis for patients with acute promyelocytic leukemia (APL), the rate of early death owing to bleeding is as high as 5%. Two recently published studies have examined the risk factors for fatal hemorrhage in APL.
In the first report, Mantha and colleagues analyzed data from five clinical trials encompassing 995 APL patients. The cumulative incidence of hemorrhagic death (HD) within 30 days of induction was 3.7% (95% confidence interval, 2.6%–5.0%). Factors significantly associated with HD were peripheral blood blast count (hazard ratio, 1.12 for each 10,000/μL increase), high white blood cell count (WBC; ≥20,000/μL vs. <20,000/μL), and low performance status (3–4 vs. 0–2). WB…