TY - JOUR
T1 - Characteristics features and factors influencing early death in Acute promyelocytic leukemia; Experience from United Arab Emirates (UAE)
AU - Hassan, Inaam Bashir
AU - Zaabi, Mariam R.Al
AU - Alam, Arif
AU - Hashim, Mohammed Jawad
AU - Tallman, Martin S.
AU - Kristensen, Jorgen
N1 - Funding Information:
This work was supported by grants from Research Affairs, United Arab Emirates University (UAEU). The authors would like to thank the staff at The National Cancer Registry, and the Medical Record Department, at Tawam Hospital, Al Ain, UAE and Ms. Ihasan Abdur-rahman, research assistant, College of Medicine and Health Sciences UAEU, for help with data entry.
Publisher Copyright:
© 2017, The Japanese Society of Hematology.
PY - 2017/7/1
Y1 - 2017/7/1
N2 - Although acute promyelocytic leukemia (APL) is a curable hematologic malignancy, early death (ED) remains a significant cause of treatment failure especially in developing countries. In a retrospective data analysis of 67 adult APL patients diagnosed in United Arab Emirates we report an ED rate of 11.9% which is comparable to that reported from more developed countries. We identified the following parameters at presentation as significant predictor of increased ED: Age >40 years (P = 0.015), fever (P = 0.030), WBC count >20 × 109/L (P = 0.010), the breakpoints other than bcr1 (P = 0.043) and fibrinogen level <1.5 g/L (P = 0.025). Delay in ATRA administration beyond 24 h from admission and fibrinogen <150 mg/dL were also significant predictors of ED, but only among high-risk patients (P = 0.035 and P = 0.033, respectively). WBC count >10 × 109/L and expression of HLA-DR (P = 0.018) or CD2 (P = 0.017) were significant predictors for differentiation syndrome (DS) which was found to be a predictor of ED (P = 0.002). Reducing the APL related ED rate in centers with limited resources is feasible provided early initiation of ATRA administration and early correction of coagulopathy in high-risk patients in addition to prompt treatment of DS. To our knowledge this is the first report from the Arabian Gulf describing ED in APL.
AB - Although acute promyelocytic leukemia (APL) is a curable hematologic malignancy, early death (ED) remains a significant cause of treatment failure especially in developing countries. In a retrospective data analysis of 67 adult APL patients diagnosed in United Arab Emirates we report an ED rate of 11.9% which is comparable to that reported from more developed countries. We identified the following parameters at presentation as significant predictor of increased ED: Age >40 years (P = 0.015), fever (P = 0.030), WBC count >20 × 109/L (P = 0.010), the breakpoints other than bcr1 (P = 0.043) and fibrinogen level <1.5 g/L (P = 0.025). Delay in ATRA administration beyond 24 h from admission and fibrinogen <150 mg/dL were also significant predictors of ED, but only among high-risk patients (P = 0.035 and P = 0.033, respectively). WBC count >10 × 109/L and expression of HLA-DR (P = 0.018) or CD2 (P = 0.017) were significant predictors for differentiation syndrome (DS) which was found to be a predictor of ED (P = 0.002). Reducing the APL related ED rate in centers with limited resources is feasible provided early initiation of ATRA administration and early correction of coagulopathy in high-risk patients in addition to prompt treatment of DS. To our knowledge this is the first report from the Arabian Gulf describing ED in APL.
KW - Acute promyelocytic leukemia
KW - Early death
KW - United Arab Emirates
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U2 - 10.1007/s12185-017-2211-7
DO - 10.1007/s12185-017-2211-7
M3 - Article
C2 - 28293819
AN - SCOPUS:85015230516
SN - 0925-5710
VL - 106
SP - 90
EP - 98
JO - International Journal of Hematology
JF - International Journal of Hematology
IS - 1
ER -