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Acute Leukemias

Continuing high early death rate in acute promyelocytic leukemia: a population-based report from the Swedish Adult Acute Leukemia Registry

Leukemia volume 25, pages 1128–1134 (2011)Cite this article

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Abstract

Our knowledge about acute promyelocytic leukemia (APL) patients is mainly based on data from clinical trials, whereas population-based information is scarce. We studied APL patients diagnosed between 1997 and 2006 in the population-based Swedish Adult Acute Leukemia Registry. Of a total of 3897 acute leukemia cases, 3205 (82%) had non-APL acute myeloid leukemia (AML) and 105 (2.7%) had APL. The incidence of APL was 0.145 per 100 000 inhabitants per year. The median age at the time of diagnosis was 54 years; 62% were female and 38% male. Among younger APL patients, female sex predominated (89% of patients <40 years). Of the 105 APL patients, 30 (29%) died within 30 days (that is, early death (ED)) (median 4 days) and 28 (26%) within 14 days from diagnosis. In all, 41% of the EDs were due to hemorrhage; 35% of ED patients never received all-trans-retinoic acid treatment. ED rates increased with age but more clearly with poor performance status. ED was also associated with high white blood cells, lactate dehydrogenase, creatinine, C-reactive protein and low platelet count. Of non-ED patients, 97% achieved complete remission of which 16% subsequently relapsed. In total, 62% are still alive at 6.4 years median follow-up. We conclude that ED rates remain very high in an unselected APL population.

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Authors and Affiliations

  1. Hematology Centre, Karolinska University Hospital, Huddinge, Stockholm and Regional Tumor Registry, Stockholm, Sweden

    S Lehmann, A Ravn, L Carlsson, S Deneberg & L Möllgård

  2. Department of Hematology and Regional Tumor Registry, Linköping University Hospital, Linköping, Sweden

    P Antunovic

  3. Center of Hematology and Regional Tumor Registry, Karolinska University Hospital, Solna, Stockholm, Sweden

    Å Rangert Derolf

  4. Department of Medicine and Regional Tumor Registry, Sahlgrenska University Hospital, Göteborg, Sweden

    D Stockelberg & L Wennström

  5. Department of Medicine, Örebro University Hospital, Örebro, Sweden

    U Tidefelt

  6. Department of Radiation Sciences, University of Umeå and Regional Tumor Registry, Norrland University Hospital, Umeå, Sweden

    A Wahlin

  7. Department of Hematology and Regional Tumor Registry, Academic Hospital, Uppsala, Sweden

    M Höglund

  8. Department of Hematology and Regional Tumor Registry, Skåne University Hospital and Lund University, Lund, Sweden

    G Juliusson

  9. Swedish Acute Myeloid Leukemia Group, Sweden

    S Lehmann, P Antunovic, L Möllgård, Å Rangert Derolf, D Stockelberg, U Tidefelt, A Wahlin, L Wennström, M Höglund & G Juliusson

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  1. S Lehmann
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Correspondence to S Lehmann.

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Lehmann, S., Ravn, A., Carlsson, L. et al. Continuing high early death rate in acute promyelocytic leukemia: a population-based report from the Swedish Adult Acute Leukemia Registry. Leukemia 25, 1128–1134 (2011). https://doi.org/10.1038/leu.2011.78

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Keywords

  • acute promyelocytic leukemia
  • incidence
  • early mortality
  • hemorrhagic death
  • population based

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