The characteristics and long-term outcomes of acute promyelocytic leukemia patients with early intracranial hemorrhage

Intracranial hemorrhage (ICH) is a major cause of early death (ED) and leads to poor prognosis in acute promyelocytic leukemia (APL). We retrospectively described 27 unselected APL patients who experienced early ICH. The ED rate was 37%. The 3-year overall survival (OS) rate was 45.4%, while the 3-year OS rate of patients who survived through induction therapy was 87.5%. No patient experienced central nervous system leukemia (CNSL). Concurrent differentiation syndrome, white blood cell count, prothrombin time and D-dimer were related to death. Although the ED rate among APL patients with early ICH was high, patients with early ICH had a favorable outcome after surviving through induction therapy. CNSL was rare despite a history of ICH during induction therapy. Compared with APL patients without ICH, it seems unnecessary to administer additional measures to prevent CNSL for this subpopulation in the era of all-trans retinoic acid and arsenic trioxide, but this needs further validation in prospective trials.

Automated summary

Intracranial hemorrhage (ICH) is a major cause of early death (ED) and poor prognosis in acute promyelocytic leukemia (APL). A retrospective study of 27 APL patients with early ICH found that the ED rate was 37% and the 3-year overall survival (OS) rate was 45.4%. However, APL patients who survived through induction therapy had a favorable 3-year OS rate of 87.5%. Central nervous system leukemia (CNSL) was not observed in any patient. Concurrent differentiation syndrome, white blood cell count, prothrombin time, and D-dimer were associated with death. It may not be necessary to administer additional measures to prevent CNSL in APL patients with early ICH in the era of all-trans retinoic acid and arsenic trioxide, but further validation is needed in prospective trials.