Risk factors for early in-hospital death in patients who developed coagulopathy during induction therapy for acute promyelocytic leukemia: a nationwide analysis in Japan

To prevent early death, management of coagulopathy is important in patients with untreated acute promyelocytic leukemia (APL). This study aimed to clarify factors associated with in-hospital death in patients with coagulopathy during induction therapy for APL. We retrospectively identified patients with newly diagnosed APL who received induction therapy including all-trans retinoic acid (ATRA) and developed coagulopathy, using a nationwide inpatient database in Japan. Of 1115 eligible patients, 175 (15%) died at a median of 13 days (interquartile range, 7-30) after admission. In the multivariable analysis, compared with younger patients (aged < 40 years), the occurrence of in-hospital death was significantly more common among older patients (aged >= 40 and < 60 years: odds ratio = 2.58 [95% confidence interval: 1.29-5.19]; aged >= 60 and < 80 years: 7.66 [3.89-15.10]; aged >= 80 years: 16.83 [7.41-38.21]). Delayed initiation of ATRA and no conventional chemotherapy were significantly associated with in-hospital death (1.79 [1.16-2.76] and 2.40 [1.47-3.92], respectively). A total of 699 patients (63%) received anticoagulant therapies, but none of these was significantly associated with lower mortality. Although the present study was constrained by a lack of laboratory findings because of database limitations, the results showed that untreated patients with APL, especially the elderly, had a poor prognosis. Immediate administration of ATRA may reduce in-hospital mortality.

Automated summary

The study aimed to identify factors associated with in-hospital death in APL patients with coagulopathy during induction therapy. Older age, delayed initiation of ATRA, and lack of conventional chemotherapy were significantly linked to higher in-hospital mortality. While 63% of patients received anticoagulant therapies, these were not associated with reduced mortality, highlighting the poor prognosis of untreated APL patients, especially the elderly. Immediate administration of ATRA may help lower in-hospital mortality.