{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T05:51:34Z","timestamp":1781589094852,"version":"3.54.5"},"reference-count":35,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100017607","name":"Shenzhen Municipal Fundamental Research Program","doi-asserted-by":"publisher","award":["JCYJ20190809142619278"],"award-info":[{"award-number":["JCYJ20190809142619278"]}],"id":[{"id":"10.13039\/501100017607","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100021171","name":"Basic and Applied Basic Research Foundation of Guangdong Province","doi-asserted-by":"publisher","award":["2023A1515030060"],"award-info":[{"award-number":["2023A1515030060"]}],"id":[{"id":"10.13039\/501100021171","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The combination of all\u2010trans retinoic acid (ATRA) with arsenic trioxide (ATO) has dramatically improved the cure rate of acute promyelocytic leukemia (APL). However, differentiation syndrome (DS) remains a significant cause of early mortality in APL patients. This severe complication typically occurs during induction therapy with ATRA and\/or ATO. Early prediction and timely intervention are crucial to reducing DS\u2010related mortality. This study aimed to identify risk factors for DS and develop a predictive model tailored to children with non\u2010high\u2010risk (NHR) APL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multicenter retrospective analysis of 166 pediatric NHR\u2010APL patients treated between 2011 and 2024. Clinical characteristics were compared between DS and non\u2010DS groups. Logistic regression was used to identify independent predictors, and a nomogram was developed based on these variables. The model was evaluated using the area under the curve (AUC) and decision curve analysis (DCA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventeen patients (10.2%) developed DS during induction. Multivariate analysis identified five independent risk factors: female sex, non\u2010chemotherapy group, BCR subtype 3, elevated peripheral promyelocyte proportion (\u2265\u200944%), and platelet count (\u2265\u200920\u2009\u00d7\u200910\n                      <jats:sup>9<\/jats:sup>\n                      \/L). The predictive nomogram achieved an AUC of 0.89 in the training set and 0.75 in the validation set. DCA demonstrated favorable clinical utility of the model.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We developed and validated the first nomogram for predicting DS in pediatric NHR\u2010APL. This tool enables early risk stratification and may guide clinical decision\u2010making to reduce early mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pds.70390","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T02:37:04Z","timestamp":1781059024000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Identification of Differentiation Syndrome During\n                    <scp>ATRA<\/scp>\n                    and Arsenic Therapy in Pediatric\n                    <scp>NHR<\/scp>\n                    \u2010\n                    <scp>APL<\/scp>\n                    : Insights From a 14\u2010Year Multicenter Cohort"],"prefix":"10.1002","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2632-011X","authenticated-orcid":false,"given":"Zhong","family":"Fan","sequence":"first","affiliation":[{"name":"The First Affiliated Hospital Sun Yat\u2010sen 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Hospital  Nanchang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liu\u2010Hua","family":"Liao","sequence":"additional","affiliation":[{"name":"Huizhou Central People's Hospital  Huizhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui\u2010Qin","family":"Chen","sequence":"additional","affiliation":[{"name":"Third Affiliated Hospital Sun Yat\u2010Sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zi\u2010Jun","family":"Zhen","sequence":"additional","affiliation":[{"name":"Sun Yat\u2010sen University Cancer Center  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang\u2010Ling","family":"He","sequence":"additional","affiliation":[{"name":"Hunan Provincial People's Hospital  Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao\u2010Qin","family":"Feng","sequence":"additional","affiliation":[{"name":"Nanfang Hospital Southern 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