There is no obvious underlying cause for de novo acute promyelocytic leukemia (APL). Recently two case studies showed that the virus torque teno mini (TTMV) has a role in the pathogenesis of APL/APL-like disease. Few studies reported seasonal or geographical clustering of the disease. As no local published research addressed the effect of these two factors on the incidence of the disease, we aimed to study the relationship between geographical and seasonal factors and the incidence of APL in the local practice. This is a retrospective medical record-based study; that looked at the characteristics of the newly diagnosed APL patients in our center over a span of 5 years. Out of 26 patients, 12 (46%) belonged to two communities that live and work in the Kingdom of Saudi Arabia (KSA) and constitute 10% of the whole country's population. While only 4 patients (15%) were Saudi, they constitute the majority (64%) of the kingdom's population. The remaining 10 (39%) patients belonged to 7 other different communities (1-2 patients each). Geographic variation in the incidence of APL can explain these differences. There was no significant statistical difference in the incidence of new APL cases by month, consecutive months, or season. More research, to study the possible role of environmental and infective factor(s) in the pathogenesis of the disease, is justified.
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