title: Administration of ATRA to newly diagnosed patients with acute promyelocytic leukemia is delayed contributing to early hemorrhagic death.
abstract: We hypothesized that the high early death rate (EDR) due to bleeding in acute promyelocytic leukemia (APL) is in part attributable to delays in all- trans retinoic acid (ATRA). We conducted a retrospective analysis of the timing of ATRA administration. 204 consecutive patients with newly diagnosed APL between 1992 and 2009 were identified. The EDR was 11%. 44% of early deaths occurred in the first week. Hemorrhage accounted for 61% of early deaths. ATRA was ordered the day APL was suspected in 31% of patients. Delays in ATRA administration led to increases in the percentage of early deaths from hemorrhage.
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States. j-altman@northwestern.edu
authors.forename: Jessica K
authors.initials: JK
authors.lastname: Altman
authors.forename: Alfred
authors.initials: A
authors.lastname: Rademaker
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cull
authors.forename: Bing Bing
authors.initials: BB
authors.lastname: Weitner
authors.forename: Yishai
authors.initials: Y
authors.lastname: Ofran
authors.forename: Todd L
authors.initials: TL
authors.lastname: Rosenblat
authors.forename: Augustin
authors.initials: A
authors.lastname: Haidau
authors.forename: Jae H
authors.initials: JH
authors.lastname: Park
authors.forename: Sharona Lee
authors.initials: SL
authors.lastname: Ram
authors.forename: James M
authors.initials: JM
authors.lastname: Orsini
authors.forename: Sonia
authors.initials: S
authors.lastname: Sandhu
authors.forename: Rosalind
authors.initials: R
authors.lastname: Catchatourian
authors.forename: Steven M
authors.initials: SM
authors.lastname: Trifilio
authors.forename: Nelly G
authors.initials: NG
authors.lastname: Adel
authors.forename: Olga
authors.initials: O
authors.lastname: Frankfurt
authors.forename: Eytan M
authors.initials: EM
authors.lastname: Stein
authors.forename: George
authors.initials: G
authors.lastname: Mallios
authors.forename: Tony
authors.initials: T
authors.lastname: Deblasio
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Jurcic
authors.forename: Stephen
authors.initials: S
authors.lastname: Nimer
authors.forename: Loann C
authors.initials: LC
authors.lastname: Peterson
authors.forename: Hau C
authors.initials: HC
authors.lastname: Kwaan
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Rowe
authors.forename: Dan
authors.initials: D
authors.lastname: Douer
authors.forename: Martin S
authors.initials: MS
authors.lastname: Tallman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced / Q000401:mortality*; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014212:Tretinoin / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D014212:Tretinoin
keywords: ATRA; Acute Promyelocytic Leukemia; Early Death Rate; Hemorrhage