Blood Journal
Leading the way in experimental and clinical research in hematology

Early death rate in acute promyelocytic leukemia remains high despite all-trans retinoic acid

  1. Jae H. Park1,
  2. Baozhen Qiao2,
  3. Katherine S. Panageas3,
  4. Maria J. Schymura2,
  5. Joseph G. Jurcic1,
  6. Todd L. Rosenblat1,
  7. Jessica K. Altman4,
  8. Dan Douer1,
  9. Jacob M. Rowe5, and
  10. Martin S. Tallman1
  1. 1Leukemia Service, Memorial Sloan-Kettering Cancer Center, New York, NY;
  2. 2New York State Cancer Registry, NY State Department of Health, Albany, NY;
  3. 3Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY;
  4. 4Northwestern University, Feinberg School of Medicine, Chicago, IL; and
  5. 5Rambam Medical Center, Technion, Haifa, Israel


The incidence of early death in a large population of unselected patients with acute promyelocytic leukemia (APL) remains unknown because of the paucity of outcome data available for patients treated outside of clinical trials. We undertook an epidemiologic study to estimate the true rate of early death with data from the Surveillance, Epidemiology, and End Results (SEER) program. A total of 1400 patients with a diagnosis of APL between 1992 and 2007 were identified. The overall early death rate was 17.3%, and only a modest change in early death rate was observed over time. The early death rate was significantly higher in patients aged ≥ 55 years (24.2%; P < .0001). The 3-year survival improved from 54.6% to 70.1% over the study period but was significantly lower in patients aged ≥ 55 years (46.4%; P < .0001). This study shows that the early death rate remains high despite the wide availability of all-trans retinoic acid and appears significantly higher than commonly reported in multicenter clinical trials. These data highlight a need to educate health care providers across a wide range of medical fields, who may be the first to evaluate patients with APL, to have a major effect on early death and the cure rate of APL.

  • Submitted April 4, 2011.
  • Accepted May 23, 2011.
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