Acute promyelocytic leukaemia: A central South African experience

Abstract

Background: Targeted therapies combined with anthracycline chemotherapy have improved the survival of patients with acute promyelocytic leukaemia (APL). High short-term mortality has been demonstrated in low- and upper-middle-income countries, with limited local data.

Aim: This study aimed to describe the demographic variables, clinical characteristics and laboratory features associated with the short-term mortality of patients with APL.

Setting: The Division of Clinical Haematology, Universitas Academic Hospital (UAH), Bloemfontein, South Africa.

Methods: Demographic and clinical data were obtained from the patients’ files and the MEDITECH electronic filing system. Laboratory data were retrieved from TrakCare, the National Health Laboratory Service (NHLS) electronic database. Data were analysed to report the demographic variables, clinical characteristics and laboratory features, and the short-term mortality of all newly diagnosed patients treated for APL during the 5-year period, 2015–2019.

Results: Twenty-seven patients were included in this study. The 7-day mortality rate was 18.5%, and the 30-day mortality rate was 33.3%. Sanz and modified Sanz scores were significantly associated with 7-day mortality but not 30-day mortality. Creatinine ≥ 105 µmol/L was significantly associated with both 7- and 30-day mortalities. Patients who died within the first 30 days of admission had significantly higher median white cell counts and partial thromboplastin times. Hypogranular APL was identified in 55.6% of patients.

Conclusion: The short-term mortality of APL at UAH is in keeping with findings at other treatment centres in middle-income countries. Despite being considered rare, hypogranular APL was the predominant type in this cohort.

Contribution: This study highlights the need for practices pertaining to peripheral smear utility and interpretation to be reviewed outside of tertiary centres.