Journal Article Ahead of print
PubMed: 41631884 DOI: 10.1080/10428194.2026.2623196
ATRA treatment in the emergency department is associated with reduced early mortality in acute promyelocytic leukemia-a real-world multicenter retrospective cohort analysis.
Leuk Lymphoma
Authors: Joseph O'Brien, Ben Tomlinson, Mayher J Patel, Koen Van Besien, Joseph Brown, Hillard Lazarus, Timothy O'Brien
Affiliations
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA.
- Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
- Department of Internal Medicine, University of Colorado, CO, USA.
- Department of Emergency Medicine, University of Colorado, Colorado, CO, USA.
Abstract
Early hemorrhagic death in acute promyelocytic leukemia (APL) remains a major, preventable cause of mortality. Although guidelines recommend empiric all-trans retinoic acid (ATRA) at first suspicion of APL, real-world initiation varies. We conducted a multicenter retrospective cohort study within the TriNetX U.S. Collaborative Network to evaluate the impact of early ATRA initiation. Adults with laboratory-confirmed APL (PML-RARA) presenting to the emergency department (ED) were categorized by ATRA initiation within 24 h (early) versus after 24 h (delayed). The primary outcome was 30-day mortality; secondary outcomes included major hemorrhage, ICU admission, thrombosis, and sepsis. Among 596 patients, 137 (23%) received early ATRA. After 1:1 propensity score matching (n = 137 per group), early ATRA was associated with lower 30-day mortality (10.2% vs 26.2%) and reduced major hemorrhage, while other outcomes did not differ. The absolute mortality risk reduction was 16%, yielding a number-needed-to-treat of seven. Early ED ATRA initiation substantially improved survival in PML-RARA-confirmed APL.
MeSH
Mortality, Hemorrhage, Leukemia, Promyelocytic, Acute, Emergencies, Neoplasms, Leukemia, Leukemia, Lymphoid, Therapeutics, Emergency Service, Hospital, Tretinoin