AUTHOR=Zhu Hong-Hu , Ma Ya-Fang , Yu Kang , Ouyang Gui-Fang , Luo Wen-Da , Pei Ren-Zhi , Xu Wei-Qun , Hu Hui-Xian , Mo Shu-Ping , Xu Xiao-Hua , Lan Jian-Ping , Shen Jian-Ping , Shou Li-Hong , Qian Shen-Xian , Feng Wei-Ying , Zhao Pu , Jiang Jin-Hong , Hu Bei-Li , Zhang Jin , Qian Su-Ying , Wu Gong-Qiang , Wu Wen-Ping , Qiu Lei , Li Lin-Jie , Lang Xiang-Hua , Chen Sai , Chen Li-Li , Guo Jun-Bin , Cao Li-Hong , Jiang Hui-Fang , Xia Yong-Ming , Le Jing , Zhao Jian-Zhi , Huang Jian , Zhang Yue-Feng , Lv Ya-Li , Hua Jing-Sheng , Hong Yong-Wei , Zheng Cui-Ping , Wang Ju-Xiang , Hu Bin-Fei , Chen Xiao-Hui , Zhang Li-Ming , Tao Shi , Xie Bing-Shou , Kuang Yue-Min , Luo Wen-Ji , Su Ping , Guo Jun , Wu Xiao , Jiang Wei , Zhang Hui-Qi , Zhang Yun , Chen Chun-Mei , Xu Xiao-Feng , Guo Yan , Tu Jin-Ming , Hu Shao , Yan Xiao-Yan , Yao Chen , Lou Yin-Jun , Jin Jie , the APL Cooperative Group of Zhejiang Province TITLE=Early Death and Survival of Patients With Acute Promyelocytic Leukemia in ATRA Plus Arsenic Era: A Population-Based Study JOURNAL=Frontiers in Oncology VOLUME=11 YEAR=2021 URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.762653 DOI=10.3389/fonc.2021.762653 ISSN=2234-943X ABSTRACT=

Most randomized trials for acute promyelocytic leukemia (APL) have investigated highly selected patients under idealized conditions, and the findings need to be validated in the real world. We conducted a population-based study of all APL patients in Zhejiang Province, China, with a total population of 82 million people, to assess the generalization of all-trans retinoic acid (ATRA) and arsenic as front-line treatment. The outcomes of APL patients were also analyzed. Between January 2015 and December 2019, 1,233 eligible patients were included in the final analysis. The rate of ATRA and arsenic as front-line treatment increased steadily from 66.2% in 2015 to 83.3% in 2019, with no difference among the size of the center (≥5 or <5 patients per year, p = 0.12) or age (≥60 or <60 years, p = 0.35). The early death (ED) rate, defined as death within 30 days after diagnosis, was 8.2%, and the 3-year overall survival (OS) was 87.9% in the whole patient population. Age (≥60 years) and white blood cell count (>10 × 109/L) were independent risk factors for ED and OS in the multivariate analysis. This population-based study showed that ATRA and arsenic as front-line treatment are widely used under real-world conditions and yield a low ED rate and a high survival rate, which mimic the results from clinical trials, thereby supporting the wider application of APL guidelines in the future.