Improving Survival Besides the High Early Mortality Rate in Acute Promyelocytic Leukemia

Abstract

The improvement in survivals of acute promyelocytic leukemia (APL) patients are still debated. In this study, we aimed to analyze the survival and early mortality (EM) rates of APL patients. In this study, de-novo APL patients who was followed up by our clinic between the years 2003-2021, were retrospectively analyzed. Patients were divided in according to their year of diagnosis, 2003-2013 (n= 33) and 2014-2021 (n= 19) groups. The 2-years survival is 52.5% and 78.9% in 2003-2013 group and 2014-2021 group, respectively, p= 0.069.The EM was not statistically different between the 2003-2013 and 2014-2021 groups (11/22 vs.4/15, p= 0.347). The 2-years survival ratio is 75.3% and 36.4% in modified-AIDA and IDA-ARA/C-ATRA treatment groups, respectively, p= 0.003. EM according to treatment groups were 7/38 versus 7/11 in modified-AIDA and IDA-ARA/C-ATRA,respectively, p= 0.001.White blood cell count >= 10000/mu l is the most important predictor of EM with overall prediction of 79.5%. The second most important factor which is related with EM is infection of patients at presentation.If these two factors are considered together there is an 84.1% overall prediction of EM. The third and last significant factors that effects EM is the induction treatment protocol. If these three significant parameters considered all together,there would be an 88.6% overall prediction of EM. The overall survival of APL patients is slightly improved between the years 2014-2021 compared to 2003-2013. The reason of this improvement is not the reduction of EM in the APL patients. Better diagnostic tools and molecular monitoring and better supportive care may have played role in the improvement of the survival of APL patients. In order to further improvement of the overall survival of APL patients, EM rates must be decreased. According to our study results, rapid and efficient treatment of infections in APL patients look like the only modifiable parameter that is related with EM.