{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T11:34:36Z","timestamp":1792150476553,"version":"4.4.0"},"reference-count":36,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HemaSphere"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Among\n                    <jats:italic>NPM1<\/jats:italic>\n                    \u2010mutated acute myeloid leukemia (AML) (\n                    <jats:italic>NPM1<\/jats:italic>\n                    <jats:sup>mut<\/jats:sup>\n                    ), a distinct subtype has been described with an immunophenotypic profile resembling acute promyelocytic leukemia (APL\u2010like). In this retrospective multicenter study including 384\n                    <jats:italic>NPM1<\/jats:italic>\n                    <jats:sup>mut<\/jats:sup>\n                    AML patients, we identified 95 (24.7%) cases exhibiting an APL\u2010like immunophenotype. This subset was characterized by significant abnormalities in coagulopathy markers (D\u2010dimer, D\u2010dimer\/fibrinogen ratio, and disseminated intravascular coagulation [DIC] score). The cumulative incidence of vascular events at 30 days was significantly higher in the APL\u2010like group compared to the non\u2010APL\u2010like group (30.5% vs. 10.1%, P\u2009&lt;\u20090.001). Notably, a higher cumulative incidence of early death due to vascular complications (within 30 days) was observed in the APL\u2010like group (6.3% vs. 0.35% in controls; P\u2009=\u20090.00015). In multivariate analysis, the APL\u2010like immunophenotype was the only significant factor associated with vascular\u2010related early death (hazard ratio [HR]\u2009=\u200919, P\u2009=\u20090.0063). There was a significantly higher rate of\n                    <jats:italic>IDH1\/2<\/jats:italic>\n                    mutations in APL\u2010like (68.3%) compared to non\u2010APL\u2010like (18.3%, P\u2009&lt;\u20090.001) cases. We validated these clinical and molecular findings in an independent validation cohort of 302\n                    <jats:italic>NPM1<\/jats:italic>\n                    <jats:sup>mut<\/jats:sup>\n                    patients enrolled in the acute myeloid leukemia study group (AMLSG) 09\u201009 clinical trial, which included the administration of all\u2010trans retinoic acid (ATRA) to all patients and a randomization for gemtuzumab ozogamicin. In this cohort, the APL\u2010like immunophenotype was associated with events occurring within the first 15 days but did not influence mortality, likely due to protocol\u2010driven patient selection. Our findings have important clinical implications that warrant the development of studies exploring disease\u2010tailored clinical measures to mitigate the risk of early vascular events, as in current APL management.\n                  <\/jats:p>","DOI":"10.1002\/hem3.70307","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T04:23:58Z","timestamp":1776399838000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["APL\u2010like subset within\n                    <i>NPM1<\/i>\n                    \u2010mutated AML: A distinct immunophenotype correlating with early vascular complications"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4810-6501","authenticated-orcid":false,"given":"Francesco","family":"Mannelli","sequence":"first","affiliation":[{"name":"Dipartimento di Medicina Sperimentale e Clinica Universit\u00e0 di Firenze Firenze 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