{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T09:08:33Z","timestamp":1788858513478,"version":"build-2803163510"},"reference-count":26,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005888","name":"Medical University of Lodz","doi-asserted-by":"publisher","award":["503\/1-093-01\/503-11-001"],"award-info":[{"award-number":["503\/1-093-01\/503-11-001"]}],"id":[{"id":"10.13039\/501100005888","id-type":"DOI","asserted-by":"publisher"}]},{"award":["503\/1-093-01\/503-11-001"],"award-info":[{"award-number":["503\/1-093-01\/503-11-001"]}],"id":[{"id":"https:\/\/ror.org\/02t4ekc95","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Secondary acute promyelocytic leukemia (sAPL) is a very rare subtype of acute myeloid leukemia that develops following exposure to chemotherapy, radiotherapy, or immunosuppressive agents. The treatment results and survival outcomes of sAPL patients are still not precisely defined. Methods: A search of the Polish Adult Leukemia Group (PALG) database identified 29 cases of sAPL (median age 57 years; 62.1% female) among 437 APL patients (6.7%) diagnosed between 2006 and 2024. Each sAPL case was matched to a de novo APL patient by sex, age, year of diagnosis, and treatment protocol (LPA (Leucemia Promieloc\u00edtica Aguda) 2005, LPA 2012, or LPA 2017). Results: All sAPL cases occurred following chemo- and\/or radiotherapy, most commonly for breast cancer. The sAPL cases demonstrated higher CD15 expression than the de novo APL cases (median 27.6% vs. 7%, p = 0.04). The two groups exhibited comparable complete remission rates (82.8% sAPL vs. 75.9% de novo; p = 0.75) and early mortality rates (17.2% vs. 20.7%, p = 1.0). However, relapse-free survival was significantly shorter in sAPL (median 94.7 months vs. not reached; HR 7.23, 95% CI 1.63\u201332.02, p = 0.030), whereas overall survival did not differ significantly between groups. Multivariate analysis identified Eastern Cooperative Oncology Group performance status \u22653 and CD15 expression &gt; 20% as independent predictors of inferior survival. Conclusions: These findings suggest that sAPL shares many clinical features with de novo APL but carries a higher risk of relapse, highlighting the need for further prospective studies and the potential implementation of tailored therapeutic strategies.<\/jats:p>","DOI":"10.3390\/cancers18182899","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T08:10:22Z","timestamp":1788855022000},"page":"2899","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Comparison of Outcomes in Patients with Secondary Acute Promyelocytic Leukemia (APL) and De Novo APL\u2014A Case-Matched Retrospective Analysis of the Polish Adult Leukemia Group (PALG)"],"prefix":"10.3390","volume":"18","author":[{"given":"Agnieszka","family":"Pluta","sequence":"first","affiliation":[{"name":"Department of Hematology, Medical University of Lodz, 90-419 Lodz, Poland"},{"name":"The Nicolas Copernicus Multidisciplinary Provincial Center of Traumatology and Oncology, 93-513 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2806-2583","authenticated-orcid":false,"given":"Damian","family":"Mikulski","sequence":"additional","affiliation":[{"name":"The Nicolas Copernicus Multidisciplinary Provincial Center of Traumatology and Oncology, 93-513 Lodz, Poland"},{"name":"Department of Biostatistics and Translational Medicine, Medical University of Lodz, 93-510 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Sobas","sequence":"additional","affiliation":[{"name":"Department of Hematology, Blood Neoplasm and Bone Marrow Transplantation, Piast Medical University, 50-367 Wroclaw, Poland"},{"name":"Department of Hematology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kinga","family":"Strza\u0142ka","sequence":"additional","affiliation":[{"name":"Department of Hematology, Medical University of Lodz, 90-419 Lodz, Poland"},{"name":"The Nicolas Copernicus Multidisciplinary Provincial Center of Traumatology and Oncology, 93-513 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8033-4662","authenticated-orcid":false,"given":"Magdalena","family":"Czemerska","sequence":"additional","affiliation":[{"name":"Department of Hematology, Medical University of Lodz, 90-419 Lodz, Poland"},{"name":"The Nicolas Copernicus Multidisciplinary Provincial Center of Traumatology and Oncology, 93-513 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominika","family":"Trybunia-Orzeszek","sequence":"additional","affiliation":[{"name":"The Nicolas Copernicus Multidisciplinary Provincial Center of Traumatology and Oncology, 93-513 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Wrobel","sequence":"additional","affiliation":[{"name":"Department of Hematology, Blood Neoplasm and Bone Marrow Transplantation, Piast Medical University, 50-367 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9482-4099","authenticated-orcid":false,"given":"Bozena","family":"Budziszewska","sequence":"additional","affiliation":[{"name":"Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marzena","family":"W\u0105tek","sequence":"additional","affiliation":[{"name":"Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewa","family":"Lech-Maranda","sequence":"additional","affiliation":[{"name":"Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Gromek","sequence":"additional","affiliation":[{"name":"Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-080 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorota","family":"Hawrylecka","sequence":"additional","affiliation":[{"name":"Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-080 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"Hus","sequence":"additional","affiliation":[{"name":"Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-080 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewa","family":"Zarzycka","sequence":"additional","affiliation":[{"name":"Department of Hematology and Transplantation, Medical University of Gdansk, 80-952 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0986-8936","authenticated-orcid":false,"given":"Jan","family":"Maciej Zaucha","sequence":"additional","affiliation":[{"name":"Department of Hematology and Transplantation, Medical University of Gdansk, 80-952 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Armatys","sequence":"additional","affiliation":[{"name":"Department of Hematology and Bone Marrow Transplantation, Medical School of Silesia, 40-032 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3703-1268","authenticated-orcid":false,"given":"Grzegorz","family":"Helbig","sequence":"additional","affiliation":[{"name":"Department of Hematology and Bone Marrow Transplantation, Medical School of Silesia, 40-032 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4185-8492","authenticated-orcid":false,"given":"Jolanta","family":"Oleksiuk","sequence":"additional","affiliation":[{"name":"Department of Hematology, Medical University Hospital, 15-276 Bialystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0141ukasz","family":"Bo\u0142kun","sequence":"additional","affiliation":[{"name":"Department of Hematology, Medical University Hospital, 15-276 Bialystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1732-8964","authenticated-orcid":false,"given":"Andrzej","family":"Szczepaniak","sequence":"additional","affiliation":[{"name":"Department of Hematology, Transplantation and Cellular Therapy, Poznan University of Medical Sciences, 60-569 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lidia","family":"Gil","sequence":"additional","affiliation":[{"name":"Department of Hematology, Transplantation and Cellular Therapy, Poznan University of Medical Sciences, 60-569 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafa\u0142","family":"Becht","sequence":"additional","affiliation":[{"name":"Clinical Department of Oncology, Chemotherapy and Cancer Immunotherapy, Pomeranian Medical University, 71-252 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wojciech","family":"Fendler","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Translational Medicine, Medical University of Lodz, 93-510 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Giebel","sequence":"additional","affiliation":[{"name":"Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Institute\u2013Cancer Center, Gliwice Branch, 44-101 Gliwice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7909-457X","authenticated-orcid":false,"given":"Agnieszka","family":"Wierzbowska","sequence":"additional","affiliation":[{"name":"Department of Hematology, Medical University of Lodz, 90-419 Lodz, Poland"},{"name":"The Nicolas Copernicus Multidisciplinary Provincial Center of Traumatology and Oncology, 93-513 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1703","DOI":"10.1038\/s41375-022-01613-1","article-title":"The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Myeloid and Histiocytic\/Dendritic Neoplasms","volume":"36","author":"Khoury","year":"2022","journal-title":"Leukemia"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1182\/blood.2022015850","article-title":"International Consensus Classification of Myeloid Neoplasms and Acute Leukemias: Integrating morphologic, clinical, and genomic data","volume":"140","author":"Arber","year":"2022","journal-title":"Blood"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/S1470-2045(17)30445-X","article-title":"Burden and centralised treatment in Europe of rare tumours: Results of RARECAREnet-a population-based study","volume":"18","author":"Gatta","year":"2017","journal-title":"Lancet Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"37","DOI":"10.21037\/sci.2019.10.03","article-title":"Incidence of acute promyelocytic leukemia across Europe: Results of RARECAREnet\u2014A population-based study","volume":"6","author":"Dinmohamed","year":"2019","journal-title":"Stem Cell Investig."},{"key":"ref_5","first-page":"27","article-title":"Secondary acute promyelocytic leukemia: Characteristics and prognosis of 14 patients from a single institution","volume":"10","author":"Pollicardo","year":"1996","journal-title":"Leukemia"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2123","DOI":"10.1200\/JCO.2003.09.072","article-title":"Therapy-related acute promyelocytic leukemia","volume":"21","author":"Beaumont","year":"2003","journal-title":"J. Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1007\/s00277-023-05582-y","article-title":"Incidence, risk factors, and outcomes of second neoplasms in patients with acute promyelocytic leukemia: The PETHEMA-PALG experience","volume":"103","author":"Sobas","year":"2024","journal-title":"Ann. Hematol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1002\/gcc.10043","article-title":"Balanced chromosome abnormalities in therapy-related myelodysplastic syndromes and acute myeloid leukemia: Report from an international workshop","volume":"33","author":"Andersen","year":"2002","journal-title":"Genes Chromosom. Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1182\/blood-2002-11-3343","article-title":"Clinical-cytogenetic associations in 306 patients with therapy-related myelodysplasia and AML: The University of Chicago series","volume":"102","author":"Smith","year":"2003","journal-title":"Blood"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Jeurkar, C., King, L., Baek, D., Wilde, L., Keiffer, G., and Kasner, M. (2026). Management of Acute Myeloid Leukemia: A Review. Cancers, 18.","DOI":"10.3390\/cancers18040659"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Krawiec, K., Strza\u0142ka, P., Czemerska, M., Wi\u015bnik, A., Zawlik, I., Wierzbowska, A., and Pluta, A. (2022). Targeting Apoptosis in AML: Where Do We Stand?. Cancers, 14.","DOI":"10.3390\/cancers14204995"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Wi\u015bnik, A., Jarych, D., Krawiec, K., Strza\u0142ka, P., Potocka, N., Czemerska, M., Sa\u0142agacka-Kubiak, A., Pluta, A., Wierzbowska, A., and Zawlik, I. (2025). Role of MicroRNAs in Acute Myeloid Leukemia. Genes, 16.","DOI":"10.3390\/genes16040446"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1002\/ajh.27628","article-title":"Clinico-Genomic Interrogation of Secondary-Type Acute Myeloid Leukemia: Response and Outcomes to Contemporary Therapies","volume":"100","author":"Senapati","year":"2025","journal-title":"Am. J. Hematol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1309\/AJCPE0MV0YTWLUUE","article-title":"Clinical and Pathologic Features of Secondary Acute Promyelocytic Leukemia","volume":"137","author":"Duffield","year":"2012","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"5137","DOI":"10.1182\/blood-2010-01-266007","article-title":"Risk-adapted treatment of acute promyelocytic leukemia based on all-trans retinoic acid and anthracycline with addition of cytarabine in consolidation therapy for high-risk patients: Further improvements in treatment outcome","volume":"115","author":"Sanz","year":"2010","journal-title":"Blood"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1056\/NEJMoa1300874","article-title":"Retinoic Acid and Arsenic Trioxide for Acute Promyelocytic Leukemia","volume":"369","author":"Avvisati","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1038\/s41408-023-00835-5","article-title":"Comparison of the 2022 and 2017 European LeukemiaNet risk classifications in a real-life cohort of the PETHEMA group","volume":"13","author":"Sargas","year":"2023","journal-title":"Blood Cancer J."},{"key":"ref_18","first-page":"379","article-title":"Patterns of leukemia incidence in the United States by subtype and demographic characteristics, 1997\u20132002","volume":"19","author":"Yamamoto","year":"2008","journal-title":"Cancer Causes Control"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.clml.2021.07.023","article-title":"Differential Survival Outcomes Between De Novo and Secondary Acute Promyelocytic Leukemia: An Updated Population-based study","volume":"22","author":"Tao","year":"2022","journal-title":"Clin. Lymphoma Myeloma Leuk."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"992","DOI":"10.18632\/oncotarget.27513","article-title":"Acute promyelocytic leukemia (APL): A review of the literature","volume":"11","author":"Jimenez","year":"2020","journal-title":"Oncotarget"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2203","DOI":"10.3390\/cancers14092203","article-title":"Prognostic and Therapeutic Role of CD15 and CD15s in Cancer","volume":"14","author":"Szlasa","year":"2022","journal-title":"Cancers"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1452","DOI":"10.1182\/blood.V78.6.1452.1452","article-title":"Enzymic control of the expression of the X determinant (CD15) in human myeloid cells during maturation: The regulatory role of 6-sialytransferase","volume":"78","author":"Skacel","year":"1991","journal-title":"Blood"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1038\/nchembio.116","article-title":"CD15 expression in human myeloid cell differentiation is regulated by sialidase activity","volume":"4","author":"Gadhoum","year":"2008","journal-title":"Nat. Chem. Biol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"5288","DOI":"10.1182\/blood-2025-5288","article-title":"CD15 expression on leukemic cells associates with extramedullary infiltration and adverse outcomes in Acute Myeloid Leukemia","volume":"146","author":"Li","year":"2025","journal-title":"Blood"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.leukres.2013.11.008","article-title":"Aberrant phenotypic expression of CD15 and CD56 identifies poor prognostic acute promyelocytic leukemia patients","volume":"38","author":"Breccia","year":"2014","journal-title":"Leuk. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2678","DOI":"10.1038\/s41375-022-01686-y","article-title":"A senescence stress secretome is a hallmark of therapy-related myeloid neoplasm stromal tissue occurring soon after cytotoxic exposure","volume":"36","author":"Kutyna","year":"2022","journal-title":"Leukemia"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/18\/2899\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T08:21:19Z","timestamp":1788855679000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/18\/2899"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,8]]},"references-count":26,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["cancers18182899"],"URL":"https:\/\/doi.org\/10.3390\/cancers18182899","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,8]]}}}