Acute Promyelocytic Leukemia: An Ambispective Institutional Experience

Abstract

Background: Acute promyelocytic leukemia (APL) is a hematologic emergency in which early hemorrhagic and treatment-related complications remain important determinants of outcome. Real-world institutional data can help characterize these challenges.

Methods: This ambispective, single-center observational cohort included 21 patients diagnosed with APL between 2021 and 2025 at Sri Aurobindo Institute of Medical Sciences, Indore. Clinical features, laboratory findings, molecular results, treatment, complications, induction response, and observed outcomes were summarized descriptively.

Results: Median age was 34 years (range, 5–72); 13 patients (61.9%) were male. Bleeding was reported in 14 (66.7%), and 15 (71.4%) had platelet counts below 40 × 10⁹/L. ATO alone was used in 13 patients (61.9%) and ATO plus ATRA in 8 (38.1%). Differentiation syndrome occurred in 11 (52.4%) and QT prolongation in 8 (38.1%). Sixteen patients (76.2%) achieved documented complete remission after induction, while five (23.8%) died before post-induction response assessment. Recorded causes of death included respiratory failure in three patients, STEMI in one, and an undocumented cause in one.

Conclusion: In this small institutional cohort, ATO-based treatment was associated with documented remission in 16 of 21 patients, while induction-phase complications and mortality remained substantial. These findings underscore the importance of rapid diagnosis, intensive supportive care, and systematic documentation. Treatment-group comparisons and time-to-event estimates are limited by the sample size and incomplete dates.