title: [Clinical features and prognostic analysis of high-risk acute promyelocytic leukemia patients].
abstract: OBJECTIVE
  To investigate the clinical features and outcomes of high-risk acute promyelocytic leukemia (APL) patients.
  
  
  METHODS
  A retrospective analysis was conducted to compare the clinical characteristics and prognosis of 118 high-risk APL patients (WBC≥10 × 10(9)/L) and 234 low and intermedia-risk patients (WBC <10×10(9)/L) from January 2003 to April 2015, who were treated in the First Affiliated Hospital of Zhejiang University and Yinzhou People's Hospital affiliated to Medical College of Ningbo University.
  
  
  RESULTS
  The initial platelet counts of high-risk APL were significantly lower than that of low and intermediate-risk groups (P=0.003); the major type of PML-RARα isoforms in high-risk patients was short-form (51.8% vs 28.2%, P <0.001); the early death (ED) rate of high-risk patients was higher than low and intermedia-risk patients (20.3% vs 2.6%, P<0.001); in contrast, the complete remission (CR) rate and 5 years estimated overall survival (OS) rate of the former were lower than the latter (76.3% vs 94.9%, P <0.001; 74.2% vs 93.7%, P <0.001). However, the CR rate (P=0.682) and 5 years estimated OS rate (P=0.481) did not have difference when the ED patients were excluded. The 5 years estimated relapse-free survival (RFS) and central nervous system (CNS) relapse were 82.7%, 9.4%, respectively, which were lower than low and intermediate-risk groups (87.8%, 1.4% ) with statistic difference (P=0.048, 0.002). High-dose cytarabine and intrathecal chemotherapy may reduce the risk of CNS relapse.
  
  
  CONCLUSIONS
  The outcomes of high-risk APL patients were worse than low and intermediate-risk group owing to the high ED rate and CNS relapse, it was important to decrease the ED rate and emphasis the CNS prophylaxis for high-risk APL patients.
authors.forename: R Z
authors.initials: RZ
authors.lastname: Pei
authors.forename: T
authors.initials: T
authors.lastname: Si
authors.forename: Y
authors.initials: Y
authors.lastname: Lu
authors.forename: P S
authors.initials: PS
authors.lastname: Zhang
authors.forename: X H
authors.initials: XH
authors.lastname: Liu
authors.forename: P P
authors.initials: PP
authors.lastname: Ye
authors.forename: D
authors.initials: D
authors.lastname: Chen
authors.forename: X H
authors.initials: XH
authors.lastname: Du
authors.forename: J X
authors.initials: JX
authors.lastname: Ma
authors.affiliation: Department & Institute of Hematology, The First Affiliated Hospital of Zhejiang University, The Key Laboratory of Hematologic Tumor (Diagnose and Treatment) of Zhejiang Province, Hangzhou 310003, China.
authors.forename: J
authors.initials: J
authors.lastname: Jin
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols; D003561:Cytarabine / Q000627:therapeutic use; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000175:diagnosis*; D007958:Leukocyte Count; D015514:Oncogene Proteins, Fusion / Q000378:metabolism; D010976:Platelet Count; D011379:Prognosis; D020033:Protein Isoforms / Q000378:metabolism; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D015514:Oncogene Proteins, Fusion; D020033:Protein Isoforms; C093476:promyelocytic leukemia-retinoic acid receptor alpha fusion oncoprotein; D003561:Cytarabine