Clinical characteristics and treatment outcomes of adult acute promyelocytic leukemia in the West Bank of Palestine: a single center retrospective study.
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BACKGROUND: Acute promyelocytic leukemia (APL), a distinct subtype of acute myeloid leukemia (AML), accounts for 5–20% of AML and carries a high risk of early, often hemorrhagic, mortality related to disseminated intravascular coagulation (DIC). With all-trans retinoic acid (ATRA) and arsenic trioxide (ATO), APL has become highly curable, with survival approaching 90%. Data from Palestine are limited. This study addresses an important regional data gap by describing the presentation, complications, and outcomes of adults with APL treated at a tertiary Palestinian cancer center and by comparing patients with and without early death. METHODS: We retrospectively reviewed 30 adults (≥18 years) diagnosed with APL at An-Najah National University Hospital (NNUH), West Bank, Palestine, between January 2016 and June 2024. Patients were classified as standard-risk (WBC ≤10×10⁹/L) or high-risk (WBC >10×10⁹/L). Standard-risk patients received ATRA+ATO induction, whereas high-risk patients received ATRA plus anthracycline-based induction. Consolidation with ATRA+ATO was given to patients who proceeded to consolidation in both groups. Early death was defined as death within 30 days of diagnosis. RESULTS: The cohort included 15 males and 15 females, with a median age of 37 years (range, 18–79 years); 22 (73.3%) were standard-risk and 8 (26.7%) were high-risk. Median baseline values were hemoglobin 9.0 g/dL, WBC 4.8×10⁹/L, platelets 18.1×10⁹/L, ANC 0.95×10⁹/L, PT 17.2 s, aPTT 27.45 s, fibrinogen 142.5 mg/dL, and D-dimer 30.9 mg/L FEU. Early death occurred in 13.3% (4/30) and was hemorrhage-related in the setting of coagulopathy/DIC. All patients who survived beyond 30 days achieved complete hematologic remission. Kaplan–Meier overall survival was 96.4% at 1 year and 87.7% at 2 years; median overall survival was 56.2 months (95% CI, 33.6–78.9). Compared with patients without early death, those with early death had higher admission WBC counts, longer aPTT, and more frequent ICU admission. CONCLUSIONS: In this single-center Palestinian cohort, ATRA-based treatment yielded high remission rates and no observed relapse during follow-up. Early mortality remained the main barrier to cure and occurred in patients presenting with a higher leukocyte burden and evidence of more severe coagulopathy. Prompt diagnosis, immediate ATRA initiation, and intensive supportive care remain essential in resource-limited settings.