title: Characteristics features and factors influencing early death in Acute promyelocytic leukemia; Experience from United Arab Emirates (UAE).
abstract: Although acute promyelocytic leukemia (APL) is a curable hematologic malignancy, early death (ED) remains a significant cause of treatment failure especially in developing countries. In a retrospective data analysis of 67 adult APL patients diagnosed in United Arab Emirates we report an ED rate of 11.9% which is comparable to that reported from more developed countries. We identified the following parameters at presentation as significant predictor of increased ED: Age >40 years (P = 0.015), fever (P = 0.030), WBC count >20 × 109/L (P = 0.010), the breakpoints other than bcr1 (P = 0.043) and fibrinogen level <1.5 g/L (P = 0.025). Delay in ATRA administration beyond 24 h from admission and fibrinogen <150 mg/dL were also significant predictors of ED, but only among high-risk patients (P = 0.035 and P = 0.033, respectively). WBC count >10 × 109/L and expression of HLA-DR (P = 0.018) or CD2 (P = 0.017) were significant predictors for differentiation syndrome (DS) which was found to be a predictor of ED (P = 0.002). Reducing the APL related ED rate in centers with limited resources is feasible provided early initiation of ATRA administration and early correction of coagulopathy in high-risk patients in addition to prompt treatment of DS. To our knowledge this is the first report from the Arabian Gulf describing ED in APL.
authors.affiliation: Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, United Arab Emirates. inaambh@uaeu.ac.ae.|Department of Oncology Tawam Hospital, AlAin, United Arab Emirates. inaambh@uaeu.ac.ae.
authors.forename: Inaam Bashir
authors.initials: IB
authors.lastname: Hassan
authors.affiliation: Department of Internal Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
authors.forename: Mariam R Al
authors.initials: MRA
authors.lastname: Zaabi
authors.affiliation: Department of Oncology Tawam Hospital, AlAin, United Arab Emirates.
authors.forename: Arif
authors.initials: A
authors.lastname: Alam
authors.affiliation: Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Abu Dhabi, United Arab Emirates.
authors.forename: Mohammed Jawad
authors.initials: MJ
authors.lastname: Hashim
authors.affiliation: Memorial Sloan Kettering Cancer Center, Rockville Centre, New York, USA.
authors.forename: Martin S
authors.initials: MS
authors.lastname: Tallman
authors.affiliation: Department of Internal Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
authors.forename: Jorgen
authors.initials: J
authors.lastname: Kristensen
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001777:Blood Coagulation; D020732:Cytogenetic Analysis; D005260:Female; D006403:Hematologic Tests; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010641:Phenotype; D011379:Prognosis; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014479:United Arab Emirates; D055815:Young Adult
keywords: Acute promyelocytic leukemia; Early death; United Arab Emirates