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- Title
Predictors of thrombohemorrhagic early death in children and adolescents with t(15;17)-positive acute promyelocytic leukemia treated with ATRA and chemotherapy.
- Authors
Abla, Oussama; Ribeiro, Raul; Testi, Anna; Montesinos, Pau; Creutzig, Ursula; Sung, Lillian; Giuseppe, Giancarlo; Stephens, Derek; Feusner, James; Powell, Bayard; Hasle, Henrik; Kaspers, Gertjan; Dalla-Pozza, Luciano; Lassaletta, Alvaro; Tallman, Martin; Locatelli, Franco; Reinhardt, Dirk; Lo-Coco, Francesco; Hitzler, Johann; Sanz, Miguel
- Abstract
Clinical trials on childhood acute promyelocytic leukemia (APL) report early death (ED) rates of 3-8%, but predictors of thrombohemorrhagic (TH)-ED are not well understood. In a retrospective study, we aimed to determine the incidence and predictors of TH-ED in childhood APL. Data were analyzed from children and adolescents with t(15;17)-positive APL (n = 683) who started treatment with all-trans retinoic acid (ATRA) and chemotherapy in different international studies. Demographic data; initial white blood cell (WBC), peripheral blood (PB) blast, and platelet counts; hemoglobin value; coagulation parameters; morphologic variant (M3 or M3v); and induction details were analyzed. Early death was defined as death occurring within 30 days of presentation. The incidence of ED was 4.7% (32 of 683 patients). Predictors of TH-ED were identified by univariable and multivariable Cox proportional hazard regression analyses (n = 25). In univariable analysis, high WBC (>10 × 109/L) (P < 0.001) and high PB blast (>30 × 109/L) (P < 0.001), M3v (P < 0.01), and black ethnicity (P < 0.001) were independent predictors of TH-ED. In multivariable analysis, high WBC count (P < 0.01) and obesity (i.e., body mass index ≥95th percentile for age) (P = 0.03) were predictors of TH-ED. Initial high WBC counts and obesity are likely predictors of TH-ED in childhood APL. The efficacy of novel drugs for APL-associated coagulopathy or of frontline arsenic trioxide and ATRA combination regimens in reducing ED rates in childhood APL remains to be established.
- Subjects
ACUTE promyelocytic leukemia; EARLY death; TRETINOIN; CANCER chemotherapy; LEUCOCYTES; PATIENTS; THERAPEUTICS; CHROMOSOME abnormalities; CHROMOSOMES; CLINICAL trials; COMPARATIVE studies; DISSEMINATED intravascular coagulation; RESEARCH methodology; MEDICAL cooperation; OBESITY; RESEARCH; EVALUATION research; LEUKOCYTE count
- Publication
Annals of Hematology, 2017, Vol 96, Issue 9, p1449
- ISSN
0939-5555
- Publication type
journal article
- DOI
10.1007/s00277-017-3042-6