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Updated: Feb 24, 2026
Assessment of the Metabolic Profile of Primary Leukemia Cells
Published on: November 21, 2018
Real-World Insights Into Acute promyelocytic leukemia (APL) in Egypt in the Absence of Arsenic Trioxide (ATO):
Yasmine Shaaban1, Dina N Laimon2, Esraa Jamal1
1Clinical Hematology Unit, Internal Medicine Department, Oncology Center Mansoura University (OCMU), Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Background:
Acute promyelocytic leukemia (APL) is a rare but highly curable subtype of acute leukemia. Despite therapeutic advances, early death (ED) within 30 days of diagnosis remains a major challenge affecting APL outcomes. In this study, the clinical, laboratory and treatment parameters were assessed and causes and risk factors for ED and non-ED were investigated and compared in a cohort of APL patients.
Patients And Methods:
This is a real-world retrospective study of 110 newly diagnosed APL patients who were diagnosed and treated at oncology center, Mansoura university between March 2011 and January 2025.
Results:
The median overall survival of 36.8 months reflects the heterogeneity of disease presentation and treatment response. Life-threatening thrombo-hemorrhagic events during the disease course particularly intracranial hemorrhage and severe thrombotic complications were associated with significantly poorer outcomes. ED occurred in 26 patients at a median of 17 days after diagnosis. Differentiation syndrome (DS) was the commonest cause of ED followed by hemorrhage and multiorgan failure. Univariate analysis associated ED with the older adults, leukocytosis, elevated neutrophil-lymphocyte ratio (NLR ≥ 0.28), thrombocytopenia, hypoalbuminemia, and elevated creatinine (> 1.2 mg/dL). Multivariate analysis identified age ≥ 38 years, leukocytosis (≥ 20 × 109/L), NLR ≥ 0.28, thrombocytopenia (≤ 50 × 109/L), and hypoalbuminemia as independent predictors of ED. Pulmonary complications during DS, elevated LDH, and renal dysfunction lacked 30-day prognostic significance.
Conclusion:
Real-world results estimated the incidence of ED at higher rates than clinical trials do. Early recognition and modification of prognostic factors, particularly DS management and supportive care, are essential to reduce ED and improve survival outcomes in APL.
