{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T17:10:20Z","timestamp":1785345020965,"version":"3.55.0"},"reference-count":73,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T00:00:00Z","timestamp":1764720000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Acute promyelocytic leukemia (APL) evolved from the most lethal to the most curable subtype of acute leukemia today, owing to targeted therapy with all-trans retinoic acid (ATRA) and arsenic trioxide. Despite cure rates exceeding 90% and the rarity of relapse or refractoriness, early death (ED)\u2014occurring within 30 days of diagnosis\u2014remains unacceptably high, reaching up to 30% in population-based studies. ED is the major barrier to universal cure, with fatal hemorrhage as the predominant cause, followed by infection, differentiation syndrome, and thrombosis. Patients who survive the initial month generally achieve excellent long-term outcomes. This review synthesizes data from clinical trials and large real-world cohorts to provide a comprehensive overview of the incidence, causes, and predictors of ED in APL. Higher white blood cell count and older age emerge as the most consistently validated predictors, followed by increased IRB\/BICcreatinine, low albumin, thrombocytopenia, and coagulopathy, although their predictive value is not uniform across studies. Risk scores such as the Sanz classification, the \u00d6sterroos ED model, and dynamic disseminated intravascular coagulation (DIC) assessments represent practical tools for identifying patients at high risk of ED. Importantly, ED rates remain significantly higher in real-world populations than in clinical trials, highlighting the impact of age and comorbidities, delayed diagnosis, and barriers to immediate ATRA initiation and supportive care. Addressing ED in APL requires intensified early supportive strategies, physician awareness and education, and rapid treatment initiation. Refinement and validation of predictive models may guide tailored interventions and inform strategies to finally overcome this persistent unmet need.<\/jats:p>","DOI":"10.3390\/medsci13040300","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T10:34:01Z","timestamp":1764758041000},"page":"300","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Predictors of Early Death in Acute Promyelocytic Leukemia"],"prefix":"10.3390","volume":"13","author":[{"given":"Joana Brioso","family":"Infante","sequence":"first","affiliation":[{"name":"Servi\u00e7o de Hematologia e Transplanta\u00e7\u00e3o de Medula, Hospital de Santa Maria, Unidade Local de Sa\u00fade de Santa Maria, 1649-028 Lisbon, Portugal"},{"name":"Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal"},{"name":"Instituto de Medicina Molecular Jo\u00e3o Lobo Antunes, 1649-028 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.1182\/blood-2019-01-894980","article-title":"Management of acute promyelocytic leukemia: Updated recommendations from an expert panel of the European LeukemiaNet","volume":"133","author":"Sanz","year":"2019","journal-title":"Blood"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.1182\/blood-2012-02-410746","article-title":"All-trans-retinoic acid, idarubicin, and IV arsenic trioxide as initial therapy in acute promyelocytic leukemia (APML4)","volume":"120","author":"Iland","year":"2012","journal-title":"Blood"},{"key":"ref_3","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_4","first-page":"1","article-title":"Early death in patients with acute promyelocytic leukemia. Proceedings from a live roundtable at the 2010 American Society of Hematology Annual Meeting, December 4\u20137, 2010, Orlando, Florida","volume":"9","author":"Tallman","year":"2011","journal-title":"Clin. Adv. Hematol. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.3324\/haematol.10874","article-title":"Clinical features and outcomes of 134 Brazilians with acute promyelocytic leukemia who received ATRA and anthracyclines","volume":"92","author":"Melo","year":"2007","journal-title":"Haematologica"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3395","DOI":"10.1182\/blood-2007-07-100669","article-title":"Causes and prognostic factors of remission induction failure in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and idarubicin","volume":"111","author":"Montesinos","year":"2008","journal-title":"Blood"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3107","DOI":"10.1080\/10428194.2019.1613540","article-title":"Acute promyelocytic leukemia (APL): Remaining challenges towards a cure for all","volume":"60","author":"Stahl","year":"2019","journal-title":"Leuk. Lymphoma"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1182\/hematology.2023000477","article-title":"How to avoid early mortality in acute promyelocytic leukemia","volume":"2023","author":"Odetola","year":"2023","journal-title":"Hematology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1084\/jem.20122337","article-title":"Uncoupling RARA transcriptional activation and degradation clarifies the bases for APL response to therapies","volume":"210","author":"Ablain","year":"2013","journal-title":"J. Exp. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3241","DOI":"10.1182\/blood.V82.11.3241.3241","article-title":"Effect of all transretinoic acid in newly diagnosed acute promyelocytic leukemia. Results of a multicenter randomized trial. European APL 91 Group","volume":"82","author":"Fenaux","year":"1993","journal-title":"Blood"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Falanga, A., Russo, L., and Montesinos, P. (2018). APL coagulopathy, In Acute Promyelocytic Leukemia, Springer International Publishing.","DOI":"10.1007\/978-3-319-64257-4_5"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1016\/j.leukres.2013.05.007","article-title":"Administration of ATRA to newly diagnosed patients with acute promyelocytic leukemia is delayed contributing to early hemorrhagic death","volume":"37","author":"Altman","year":"2013","journal-title":"Leuk. Res."},{"key":"ref_13","unstructured":"Platzbecker, U., Ad\u00e8s, L., Montesinos, P., Ammatuna, E., Fenaux, P., Baldus, C., Berthon, C., Bocchia, M., Bonmati, C., and Borlenghi, E. (2024, January 13\u201316). First results of the APOLLO trial: A randomized phase III study to compare ATO combined with ATRA versus standard AIDA regimen for patients with newly diagnosed, high-risk acute promyelocytic leukemia. Proceedings of the 2024 European Hematology Association Congress, Madrid, Spain. Abstract S102."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1038\/leu.2011.78","article-title":"Continuing high early death rate in acute promyelocytic leukemia: A population-based report from the Swedish Adult Acute Leukemia Registry","volume":"25","author":"Lehmann","year":"2011","journal-title":"Leukemia"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"570","DOI":"10.3324\/haematol.2021.279052","article-title":"Timely diagnosis and treatment of acute promyelocytic leukemia should be available to all","volume":"107","author":"Schuh","year":"2022","journal-title":"Haematologica"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1038\/leu.2017.71","article-title":"Early death rates remain high in high-risk APL: Update from the Swedish Acute Leukemia Registry 1997\u20132013","volume":"31","author":"Lehmann","year":"2017","journal-title":"Leukemia"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1111\/bjh.12931","article-title":"Acute promyelocytic leukaemia is characterized by stable incidence and improved survival that is restricted to patients managed in leukaemia referral centres: A pan-Canadian epidemiological study","volume":"166","author":"Paulson","year":"2014","journal-title":"Br. J. Haematol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1182\/blood-2011-04-346437","article-title":"Early death rate in acute promyelocytic leukemia remains high despite all-trans retinoic acid","volume":"118","author":"Park","year":"2011","journal-title":"Blood"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"133","DOI":"10.3324\/haematol.2011.046490","article-title":"Treatment advances have not improved the early death rate in acute promyelocytic leukemia","volume":"97","author":"Mcclellan","year":"2012","journal-title":"Haematologica"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e78","DOI":"10.1016\/j.clml.2022.11.005","article-title":"Improvement of Early Death in Acute Promyelocytic Leukemia: A Population-Based Analysis","volume":"23","author":"Li","year":"2022","journal-title":"Clin. Lymphoma Myeloma Leuk."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"101522","DOI":"10.1016\/j.tranon.2022.101522","article-title":"Evolving of treatment paradigms and challenges in acute promyelocytic leukaemia: A real-world analysis of 1105 patients over the last three decades","volume":"25","author":"Diyaer","year":"2022","journal-title":"Transl. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1182\/blood.V94.4.1192","article-title":"A randomized comparison of all transretinoic acid (ATRA) followed by chemotherapy and ATRA plus chemotherapy and the role of maintenance therapy in newly diagnosed acute promyelocytic leukemia. The European APL Group","volume":"94","author":"Fenaux","year":"1999","journal-title":"Blood"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3171","DOI":"10.1182\/blood-2010-03-276196","article-title":"Front-line treatment of acute promyelocytic leukemia with AIDA induction followed by risk-adapted consolidation for adults younger than 61 years: Results of the AIDA-2000 trial of the GIMEMA Group","volume":"116","author":"Avvisati","year":"2010","journal-title":"Blood"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"4131","DOI":"10.1182\/blood.V93.12.4131","article-title":"Presenting white blood cell count and kinetics of molecular remission predict prognosis in acute promyelocytic leukemia treated with all-trans retinoic acid: Result of the Randomized MRC Trial","volume":"93","author":"Burnett","year":"1999","journal-title":"Blood"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2248","DOI":"10.1038\/leu.2009.183","article-title":"High dose ara-C in the treatment of newly diagnosed acute promyelocytic leukemia: Long-term results of the German AMLCG","volume":"23","author":"Lengfelder","year":"2009","journal-title":"Leukemia"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1182\/blood-2003-07-2462","article-title":"Risk-adapted treatment of acute promyelocytic leukemia with all-trans-retinoic acid and anthracycline monochemotherapy: A multicenter study by the PETHEMA group","volume":"103","author":"Sanz","year":"2004","journal-title":"Blood"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1935","DOI":"10.1182\/blood-2012-08-449918","article-title":"Improving acute promyelocytic leukemia (APL) outcome in developing countries through networking, results of the International Consortium on APL","volume":"121","author":"Rego","year":"2013","journal-title":"Blood"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Gill, H., Raghupathy, R., Lee, C.Y.Y., Yung, Y., Chu, H.-T., Ni, M.Y., Xiao, X., Flores, F.P., Yim, R., and Lee, P. (2023). Acute promyelocytic leukaemia: Population-based study of epidemiology and outcome with ATRA and oral-ATO from 1991 to 2021. BMC Cancer, 23.","DOI":"10.1186\/s12885-023-10612-z"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/j.leukres.2014.06.011","article-title":"Delay in the administration of all-trans retinoic acid and its effects on early mortality in acute promyelocytic leukemia: Final results of a multicentric study in the United States","volume":"38","author":"Rashidi","year":"2014","journal-title":"Leuk. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1528","DOI":"10.3324\/haematol.2021.280093","article-title":"A risk score based on real-world data to predict early death in acute promyelocytic leukemia","volume":"107","author":"Maia","year":"2022","journal-title":"Haematologica"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1182\/blood.2024026186","article-title":"Acute promyelocytic leukemia: Long-term outcomes from the HARMONY project","volume":"145","author":"Voso","year":"2025","journal-title":"Blood"},{"key":"ref_32","first-page":"169","article-title":"Improving Outcomes of Acute Promyelocytic Leukemia in the Current Era: Analysis of the SEER Database","volume":"18","author":"Szabo","year":"2020","journal-title":"J. Nat. Compr. Cancer Netw."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1182\/blood-2016-02-699439","article-title":"The 12-year follow-up of survival, chronic adverse effects, and retention of arsenic in patients with acute promyelocytic leukemia","volume":"128","author":"Zhu","year":"2016","journal-title":"Blood"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.1080\/10428194.2021.1894651","article-title":"Early mortality and overall survival in acute promyelocytic leukemia: Do real-world data match results of the clinical trials?","volume":"62","author":"Dhakal","year":"2021","journal-title":"Leuk Lymphoma"},{"key":"ref_35","first-page":"795","article-title":"Early death and intracranial hemorrhage prediction in acute promyelocytic leukemia: Validation of a risk score in a cohort from an international consortium treated with chemotherapy plus all-trans retinoic acid","volume":"110","author":"Silva","year":"2025","journal-title":"Haematologica"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1007\/s00432-019-03076-x","article-title":"Comparative analysis of causes and predictors of early death in elderly and young patients with acute promyelocytic leukemia treated with arsenic trioxide","volume":"146","author":"Jin","year":"2020","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"762653","DOI":"10.3389\/fonc.2021.762653","article-title":"Early Death and Survival of Patients With Acute Promyelocytic Leukemia in ATRA Plus Arsenic Era: A Population-Based Study","volume":"11","author":"Zhu","year":"2021","journal-title":"Front Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1865","DOI":"10.1038\/s41375-025-02663-x","article-title":"Comparison of induction with arsenic trioxide or chemotherapy in a real-world cohort of patients with high-risk acute promyelocytic leukemia","volume":"39","author":"Lebon","year":"2025","journal-title":"Leukemia"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2894","DOI":"10.1182\/blood-2024-210470","article-title":"Improved Real-World Outcomes of Patients with Acute Promyelocytic Leukemia Treated with First-Line Arsenic Trioxide in Specialized Centers in Portugal through a 24\/7 Phone-Based Referral: A Study from the Portuguese Acute Leukemia Group","volume":"144","author":"Aguiar","year":"2024","journal-title":"Blood"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1016\/j.ejca.2013.11.023","article-title":"Management and treatment results in patients with acute promyelocytic leukaemia (APL) not enrolled in clinical trials","volume":"50","author":"Micol","year":"2014","journal-title":"Eur. J. Cancer"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"3031","DOI":"10.1007\/s00277-023-05422-z","article-title":"Predictors of very early death in acute promyelocytic leukemia: A retrospective real-world cohort study","volume":"102","author":"Infante","year":"2023","journal-title":"Ann. Hematol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"853","DOI":"10.3324\/haematol.2009.017962","article-title":"Early hemorrhagic death before starting therapy in acute promyelocytic leukemia: Association with high WBC count, late diagnosis and delayed treatment initiation","volume":"95","author":"Breccia","year":"2010","journal-title":"Haematologica"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2777","DOI":"10.1182\/blood-2013-10-512640","article-title":"How we prevent and treat differentiation syndrome in patients with acute promyelocytic leukemia","volume":"123","author":"Sanz","year":"2014","journal-title":"Blood"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Hambley, B.C., Tomuleasa, C., and Ghiaur, G. (2021). Coagulopathy in Acute Promyelocytic Leukemia: Can We Go Beyond Supportive Care?. Front. Med., 8.","DOI":"10.3389\/fmed.2021.722614"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Abla, O., Coco, F.L., and Sanz, M.A. (2018). Acute Promyelocytic Leukemia: A Clinical Guide, Springer International Publishing.","DOI":"10.1007\/978-3-319-64257-4"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"292","DOI":"10.7326\/0003-4819-117-4-292","article-title":"The \u201cRetinoic Acid Syndrome\u201d in Acute Promyelocytic Leukemia","volume":"117","author":"Frankel","year":"1992","journal-title":"Ann. Intern. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e2011059","DOI":"10.4084\/mjhid.2011.059","article-title":"The differentiation syndrome in patients with acute promyelocytic leukemia: Experience of the pethema group and review of the literature","volume":"3","author":"Montesinos","year":"2011","journal-title":"Mediterr. J. Hematol. Infect. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1111\/bjh.16151","article-title":"Differentiation syndrome in acute promyelocytic leukaemia","volume":"187","author":"Stahl","year":"2019","journal-title":"Br. J. Haematol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1182\/blood-2008-07-168617","article-title":"Differentiation syndrome in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and anthracycline chemotherapy: Characteristics, outcome, and prognostic factors","volume":"113","author":"Montesinos","year":"2009","journal-title":"Blood"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1474","DOI":"10.1093\/annonc\/mdw171","article-title":"Current management of newly diagnosed acute promyelocytic leukemia","volume":"27","author":"Cicconi","year":"2016","journal-title":"Ann. Oncol."},{"key":"ref_51","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_52","doi-asserted-by":"crossref","first-page":"e9324","DOI":"10.1097\/MD.0000000000009324","article-title":"Analysis of early death in newly diagnosed acute promyelocytic leukemia patients","volume":"96","author":"Xu","year":"2017","journal-title":"Medicine"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.1182\/blood-2016-10-747170","article-title":"Determinants of fatal bleeding during induction therapy for acute promyelocytic leukemia in the ATRA era","volume":"129","author":"Mantha","year":"2017","journal-title":"Blood"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"4716","DOI":"10.1182\/blood-2010-08-302950","article-title":"AIDA 0493 protocol for newly diagnosed acute promyelocytic leukemia: Very long-term results and role of maintenance","volume":"117","author":"Avvisati","year":"2011","journal-title":"Blood"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.leukres.2010.05.022","article-title":"Significance of fibrinogen, D-dimer, and LDH levels in predicting the risk of bleeding in patients with acute promyelocytic leukemia","volume":"35","author":"Kim","year":"2011","journal-title":"Leuk. Res."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"3480","DOI":"10.1007\/s00415-021-10441-9","article-title":"Cerebrovascular manifestations in hematological diseases: An update","volume":"268","author":"Ferro","year":"2021","journal-title":"J. Neurol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"4917","DOI":"10.2147\/OTT.S144438","article-title":"Low platelet count is potentially the most important contributor to severe bleeding in patients newly diagnosed with acute promyelocytic leukemia","volume":"10","author":"Song","year":"2017","journal-title":"OncoTargets Ther."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.thromres.2021.12.020","article-title":"Predictive factors for differentiating thrombohemorrhagic disorders in high-risk acute promyelocytic leukemia","volume":"210","author":"Xiao","year":"2022","journal-title":"Thromb. Res."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1111\/j.1600-0609.2011.01747.x","article-title":"Clinical bleeding events and laboratory coagulation profiles in acute promyelocytic leukemia","volume":"88","author":"Chang","year":"2012","journal-title":"Eur. J. Haematol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1739","DOI":"10.1182\/blood-2017-02-763490","article-title":"Predicting APL lethal bleeding in the ATRA era","volume":"129","author":"Falanga","year":"2017","journal-title":"Blood"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1672","DOI":"10.1038\/leu.2016.69","article-title":"Comprehensive mutational analysis of primary and relapse acute promyelocytic leukemia","volume":"30","author":"Madan","year":"2016","journal-title":"Leukemia"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Picharski, G.L., Andrade, D.P., Fabro, A.L.M.R., Lenzi, L., Tonin, F.S., Ribeiro, R.C., and Figueiredo, B.C. (2019). The Impact of Flt3 Gene Mutations in Acute Promyelocytic Leukemia: A Meta-Analysis. Cancers, 11.","DOI":"10.3390\/cancers11091311"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"2371","DOI":"10.2147\/CMAR.S297421","article-title":"Potential Effects of the FLT3-ITD Mutation on Chemotherapy Response and Prognosis of Acute Promyelocytic Leukemia","volume":"13","author":"Song","year":"2021","journal-title":"Cancer Manag. Res."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"107392","DOI":"10.1016\/j.leukres.2023.107392","article-title":"Factors associated with thrombo-hemorrhagic deaths in patients with Acute Promyelocytic leukemia treated with Arsenic Trioxide and all-trans retinoic acid","volume":"134","author":"Singh","year":"2023","journal-title":"Leuk. Res."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1111\/j.1538-7836.2007.02313.x","article-title":"The scoring system of the Scientific and Standardisation Committee on Disseminated Intravascular Coagulation of the International Society on Thrombosis and Haemostasis: A 5-year overview","volume":"5","author":"Toh","year":"2007","journal-title":"J. Thromb. Haemost."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1007\/s12032-013-0478-y","article-title":"International Society of Thrombosis and Hemostasis Scoring System for disseminated intravascular coagulation \u22656: A new predictor of hemorrhagic early death in acute promyelocytic leukemia","volume":"30","author":"Mitrovic","year":"2013","journal-title":"Med. Oncol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1007\/s00277-022-04798-8","article-title":"The evaluation of risk factors leading to early deaths in patients with acute promyelocytic leukemia: A retrospective study","volume":"101","author":"Baysal","year":"2022","journal-title":"Ann. Hematol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1111\/ejh.14177","article-title":"Disseminated intravascular coagulation score evolution in 48\u2009h predicts early death in acute promyelocytic leukemia patients","volume":"112","author":"Infante","year":"2024","journal-title":"Eur. J. Haematol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1182\/blood-2020-143138","article-title":"Disseminated intravascular coagulation score evolution in 48 hours predicts early death in newly-diagnosed chemotherapy-treated acute promyelocytic leukemia patients","volume":"136","author":"Infante","year":"2020","journal-title":"Blood"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1046\/j.1365-2141.2000.01936.x","article-title":"Early haemorrhagic morbidity and mortality during remission induction with or without all-trans retinoic acid in acute promyelocytic leukaemia","volume":"108","author":"Avvisati","year":"2000","journal-title":"Br. J. Haematol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.thromres.2004.11.001","article-title":"Predictive factors of bleeding and thrombosis during induction therapy in acute promyelocytic leukemia\u2014A single center experience in 34 patients","volume":"116","author":"Dally","year":"2005","journal-title":"Thromb. Res."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1111\/j.1600-0609.2006.00803.x","article-title":"Severe hemorrhagic complications during remission induction therapy for acute promyelocytic leukemia: Incidence, risk factors, and influence on outcome","volume":"78","author":"Yanada","year":"2007","journal-title":"Eur. J. Haematol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1001\/jamaoncol.2024.7033","article-title":"Academic Community Partnership in Acute Promyelocytic Leukemia and Early Mortality","volume":"11","author":"Jillella","year":"2025","journal-title":"JAMA Oncol."}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/13\/4\/300\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T10:59:00Z","timestamp":1764759540000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/13\/4\/300"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,3]]},"references-count":73,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["medsci13040300"],"URL":"https:\/\/doi.org\/10.3390\/medsci13040300","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,3]]}}}