Comparative analysis of causes and predictors of early death in elderly and young patients with acute promyelocytic leukemia treated with arsenic trioxide

  • Bo Jin
  • Yingmei Zhang
  • Wenyi Hou
  • Fenglin Cao
  • Ming Lu
  • Huiyuan Yang
  • Xuanyu Tian
  • Yuan Wang
  • Jinxiao Hou
  • Jinyue Fu
  • Haitao Li
  • Jin ZhouEmail author
Original Article – Clinical Oncology



Early death (ED) is the main cause of acute promyelocytic leukemia (APL) treatment failure, and the ED rate is higher for elderly patients than that for young ones. To date, no studies have been found focusing on ED in elderly patients with APL.


This study retrospectively analyzed the clinical data of 409 consecutive patients with APL (139 patients ≥ 50 years old, 270 patients < 50 years old). All patients received arsenic trioxide alone as induction therapy. The baseline clinical characteristics and ED occurrence and predictors between elderly and young patients with APL were compared and analyzed.


The clinical features of elderly patients at admission were not significantly different from those of young ones. The ED rate of elderly patients was significantly greater than that of young patients (23.74% vs 11.85%, P = 0.0018). Hemorrhage is the main cause of ED in elderly patients, followed by infection and differentiation syndrome. From the 15th to 30th days of treatment, elderly patients had a higher mortality rate than that of young patients (7.83% vs 2.06%, P = 0.009). Male, white blood cell (WBC) count > 10 × 109/L, fibrinogen < 1.0 g/L and low albumin levels were independent risk factors for ED in elderly patients, while ED was only correlated with WBC count, fibrinogen and creatinine levels in young patients.


The results of this study may help design more rational treatment plans for elderly patients with APL based on early mortality risk to reduce the ED rate.


Acute promyelocytic leukemia Elderly patient Early death Arsenic trioxide 



Acute promyelocytic leukemia


Early death


Arsenic trioxide




White blood cell






Aspartate aminotransferase






Uric acid


Hazard ratio


Confidence interval


Differentiation syndrome


Disseminated intravascular coagulation


All-trans retinoic acid


Lactate dehydrogenase


Eastern Cooperative Oncology Group performance status


Central nervous system


Author contributions

BJ conceived, designed, analyzed the data, and wrote the manuscript. YZ conceived, designed, and participated in data analysis. JZ analyzed data and is the corresponding author. WH, FC and ML analyzed the data. HY, XT, YW, JH, JF and HL participated in data collection. All authors reviewed the manuscript. All authors read and approved the final manuscript.


This work was supported by the National Natural Science Foundation of China (No. 81270589), and Natural Science Foundation of Heilongjiang Province (No. H2017032).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This study protocol was discussed and approved by the Medical Ethics Committee of the First Affiliated Hospital of Harbin Medical University who waived the need for patient informed consent for this retrospective analysis.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of HematologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinPeople’s Republic of China
  2. 2.Department of Central LaboratoryThe First Affiliated Hospital of Harbin Medical UniversityHarbinPeople’s Republic of China
  3. 3.Maternal and Child Health Care Hospital of Heilongjiang ProvinceHarbinPeople’s Republic of China

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