title: Clinical characteristics, outcome and early induction deaths in patients with acute promyelocytic leukaemia: a five-year experience at a tertiary care centre.
abstract: BACKGROUND
  Acute promyelocytic leukaemia (APL) is a distinct clinical and biological subtype of acute myeloid leukaemia. APL is notorious for causing early death during induction therapy, resulting in induction failure. The aim of our study was to report the clinical characteristics, outcome and early induction deaths with regard to patients with APL seen at our hospital.
  
  
  METHODS
  This was a retrospective study carried out at Aga Khan University Hospital, Karachi, Pakistan. Patients aged > 15 years diagnosed with APL within the period September 2007-September 2012 were included in the study.
  
  
  RESULTS
  Within the study period, 26 patients were diagnosed with APL based on morphology and the detection of t(15;17)(q24.1;q21.1) and promyelocytic leukaemia-retinoic acid receptor alpha (PML-RARA). The male to female ratio was 1:1. The median age of the patients was 41 (range 16-72) years. In all, there were 13 (50.0%) high-risk patients, and early induction death rate was 61.5%. Causes of early induction deaths (n = 16) included haemorrhage in 7 (43.8%) patients, differentiation (ATRA) syndrome in 7 (43.8%) and infection in 2 (12.5%). The survival rate among patients who survived the early period was 70% at 42 months. The relapse rate was 30%.
  
  
  CONCLUSIONS
  Early induction death rate was very high in patients with APL. The most common cause of early induction death in our study was haemorrhage. Outcome among patients with APL was found to be better among those who survived the initial period.
authors.affiliation: Section of Hematology, Department of Pathology and Microbiology, Aga Khan University Hospital, Stadium Road, Karachi 74800, Pakistan. farheen.mahar@aku.edu.
authors.forename: Farheen
authors.initials: F
authors.lastname: Karim
authors.forename: Usman
authors.initials: U
authors.lastname: Shaikh
authors.forename: Salman Naseem
authors.initials: SN
authors.lastname: Adil
authors.forename: Mohammad
authors.initials: M
authors.lastname: Khurshid
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D012008:Recurrence; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013997:Time Factors; D014178:Translocation, Genetic; D016896:Treatment Outcome; D055815:Young Adult