Risk factors for early in-hospital death in patients who developed coagulopathy during induction therapy for acute promyelocytic leukemia: a nationwide analysis in Japan

Institutional factors associated with early mortality of newly diagnosed acute promyelocytic leukemia

“…However, previous real-world studies showed that early mortality was still high in unselected APL populations [6][7][8]. Our nationwide study also demonstrated that although all patients received ATRA, early mortality reached 16% in a real-world clinical setting in Japan [9]. The present study aimed to assess the association between institutional factors and early death during induction therapy for untreated APL, using a Japanese nationwide inpatient database.…”

“…In addition, because >70% of patients with APL were reported to develop coagulopathy [13], we further selected patients who required fresh frozen plasma (FFP) transfusion within 3 days of admission to more accurately identify APL patients from the database. This definition was also used in our previous studies [9,14]. Patient covariates included age, sex, body mass index (BMI), activities of daily living, Charlson comorbidity index (CCI) [15], initial FFP transfusion volume (i.e., initial transfusion volume of FFP per body weight within 3 days of admission), and emergency admission.…”

“…The CCI was scored using diagnoses for individual patients and was categorized into 2 or ≥3. Initial FFP transfusion volume (ml/kg) was categorized into three groups and used as a proxy indicator for the severity of coagulopathy [9]. In addition to these patients' baseline factors, we added the following institutional covariates: hospital volume, location of hospital, educational hospital, the number of beds in each hospital, and the number of hematologists per population in each prefecture.…”

Prompt Initiation of Conventional Chemotherapy to Avoid Early Death in Patients with Newly Diagnosed Acute Promyelocytic Leukemia

“…Two Japanese studies published at a similar timing showed a large difference in early death rates: 4.7% in the prospective study and 16% in the real-world study (9,16). In day-to-day practice, preventing early death remains an important issue in patients with newly diagnosed APL.…”

“…To date, early death in patients with newly diagnosed APL remains a critical issue, and the establishment of strategies to prevent early death is warranted. Among real-world studies, while nationwide population-based studies have shown a similarly high early mortality for newly diagnosed APL, single-and multi-center retrospective studies have shown varied early death rates (7)(8)(9)(10)(11)(12)(13). We therefore hypothesized that the therapeutic approach at each institute might be important for preventing early death.…”