Real-World Outcomes in Acute Promyelocytic Leukemia: A 13-Year Cohort from Qatar

Acute promyelocytic leukemia (APL) is among the most curable acute leukemias, but real-world early mortality continues to undermine population-level cure. This study evaluated long-term outcomes and prognostic factors among adults with APL treated in a single tertiary center in Qatar.

We conducted a retrospective cohort study of consecutive adult patients diagnosed with APL between 2012 and 2024. Baseline demographic, clinical, and laboratory data, treatment regimens, and response outcomes were extracted from electronic medical records. Patients were stratified according to Sanz risk criteria. Overall survival (OS) was estimated using the Kaplan-Meier method, and prognostic factors were assessed using log-rank tests and Cox proportional hazards regression.

A total of 87 patients were included (median age: 36 years; 47.1% high-risk groups by Sanz criteria). Early mortality within 30 days occurred in 26.4% (n = 23), predominantly due to intracranial hemorrhage (47.8% of early deaths). Among 71 patients who received treatment, the complete remission (CR) rate was 84.1%, with the highest CR observed in those treated with all-trans retinoic acid (ATRA)-arsenic trioxide (90.9%). Treatment-related complications occurred in 73.2% of patients, most commonly infections (66.2%) and differentiation syndrome (21.1%). Three-year OS was 93% in low-risk groups, 88% in intermediate-risk groups, and 56% in high-risk groups (log-rank p = 0.001). In multivariable analysis, ICU admission (hazard ratio [HR]: 5.42) and lack of treatment initiation (HR: 8.06) were independent predictors of mortality. Excluding patients presenting with intracranial hemorrhage, early mortality decreased to 14.7%, and 5-year OS improved to 87.6%.

Despite the effectiveness of contemporary APL therapies, early mortality, primarily driven by hemorrhagic complications, remains a significant challenge. Strategies to improve outcomes should focus on rapid diagnosis, immediate initiation of empiric ATRA, and aggressive correction of coagulopathy. Integration of APL-specific emergency care pathways may represent a key opportunity to reduce preventable deaths.