Pb1891: early death in acute promyelocytic leukemia in southern tunisia

Topic: 4. Acute myeloid leukemia - Clinical Background: Despite the improvement treatment in acute promyelocytic leukemia (APL), early death rate, 30 days following the diagnosis, remained higher (14 à 40%). Aims: We reported in this study, clinical and biological characteristic of patients with APL, died early. Methods: Our retrospective study concerned all patients with APL with the diagnosis of APL and followed in the hematology department of Hedi Chaker Hospital Sfax, from January 2000 until December 2019. The diagnosis of APL is based on morphological, cytogenetic and molecular study. The treatment is based on all-trans retinoic acid (ATRA) and chemotherapy regimens. We included patients died early 30 days following the diagnosis. Results: Among 79 patients with APL, twenty three patients died early (30% of cases). The median age was 31 years (extreme: 2-75 years) with sex ratio 1,3. Obesity with BMI more than 25 was noted in 65% of cases. An average delay between symptoms and diagnosis was 10 days. Hyperleukocytosis more than 10000/mm3 (high risk group) was noted in 78% of cases. Thrombopenia (platelets<40000/mm3) was noted in 91% of cases, with disseminated intravascular coagulation (DIC) founded in the majority of cases (96% of cases). Nineteen patients (83%) had hemorrhage syndrome at diagnosis. Eight patients died before treatment, between one and two days of diagnosis. Fifteen patients died early during the induction course before evaluation with an average delay of 8 days (extreme: 2-28). Causes of death before treatment were haemorrhage in seven cases (87.5%). Causes of death during treatment were multiple: respiratory disease due to the differentiation syndrome, a severe haemorrhagic syndrome and or septic shock. Summary/Conclusion: Early death rate is similar to that reported in the literature. Older age, hyper-leukocyte forms, DIC and delay in diagnosis were risk factors in our study. Early diagnosis of APL is essential to reduce the mortality rate and improve overall survival, by establishing early support treatment and administration ATRA therapy as soon as the diagnosis is suspected. By the other way, the use of combined ATRA and arsenic trioxide without chemotherapy, in non-high-risk patients could be an alternative to reduce hematology toxicity and early death rate. Keywords: Hemorrhage, Mortality, Acute promyelocytic leukemia