How to avoid early mortality in acute promyelocytic leukemia

Acute promyelocytic leukemia (APL), a phenotypically and genotypically unique subtype of acute myeloid leukemia, has seen unprec e dented advances in its man age ment since the intro duc tion of all - trans retinoic acid (ATRA) and arse nic triox ide. However, the phe nom e nal phar ma co logic con ver sion of this once highly fatal dis ease to one with a long - term survival exceed ing 90 % among patients who sur vive induc tion remains impaired by the sig nifi cant inci dence of early death (ED) reaching 30 % in some real - world stud ies. The key driver for ED in APL is cat a strophic hem or rhage with a pro cliv ity for cra nial sites. Most EDs in APL are cur rently con sid ered pre vent able. Here, we dis cuss the con cept of early death in APL and its char ac ter is tics. Importantly, we out line implementable strat e gies to reduce the inci dence of ED. Early rec og ni tion of APL under pins these pre ven tive mea sures as sig nifi cant delays in the diag no sis increase the like li hood of ED. While early admin is tra tion of ATRA is often taught to all hema tol ogy train ees, this life sav ing inter ven tion is only pos si ble if provid ers, includ ing those in emer gency depart ments and urgent / imme di ate care set tings, are trained to have a high index of suspicion and competence to recognize the morphologic and clinical characteristics of the disease. Other proposed strat e gies tackle the com pli ca tions that can be pres ent at diag no sis or arise dur ing induc tion ther apy and address the issues of expert con sul ta tion and pro to col adher ence in the man age ment of these patients. While some of these measures appear intu i tive and oth ers aspi ra tional, wide spread adop tion could bring about an era of cure for almost every patient with APL.