Disseminated intravascular coagulation score evolution in 48 h predicts early death in acute promyelocytic leukemia patients

Abstract Introduction Early death (ED) is the unsolved issue of acute promyelocytic leukemia (APL). The disseminated intravascular coagulation (DIC) score has been proposed as a marker of bleeding and death in APL; whether its temporal evolution predicts outcomes in APL is unknown. We evaluated whether an increasing score 48 h after diagnosis associates with ED. Methods Retrospective, single‐center study, including patients with newly diagnosed APL between 2000 and 2023, treated with all‐transretinoic acid (ATRA) plus anthracycline or arsenic trioxide (ATO). “DIC score worsening” was defined as ≥1 point increase in the score after 48 h, and ED as death within 30 days of diagnosis. Results Eighty‐six patients were included, with median age of 46 years (17–82). ED patients (26.7%) more frequently had age >60 years and worsening DIC score after 48 h. These were also the only predictors of ED identified in both univariate and multivariate (OR 4.18, p = .011; OR 7.8, p = .005, respectively) logistic regression analysis. Conclusion This is the first study on DIC score evolution in APL—a worsening DIC score 48 h after diagnosis is a strong independent predictive factor of ED. We propose a reduction of the DIC score from diagnosis as a new treatment goal in APL care.