Predictors of early hemorrhage in acute promyelocytic leukemia

Fatal hemorrhage is the most common cause of induction failure and death among patients with acute promyelocytic leukemia (APL). However, there remains no established means of hemorrhagic risk stratification in APL. In this single center retrospective study of 43 patients treated for APL group-based trajectory modeling was used to identify laboratory trends associated with major bleeding. Bleeding risk was significantly associated with particular trends in white blood cell count (WBC) and lactate dehydrogenase level (LDH). Specifically, patients who presented with high WBC and/or LDH, and whose WBC and/or LDH then proceeded to uptrend during the initial days of induction, were significantly more likely to experience major bleeding (p = .0111 and p = .0143, respectively). Additionally, there appeared to be a temporal association between WBC and LDH trends and major bleeding events. Among nonlaboratory variables, differentiation syndrome (DS) was significantly associated with major bleeding (p = .00149).