Thromboembolism in adult patients with acute promyelocytic leukemia: clinical characteristics, risk factors, and a predictive nomogram

Acute promyelocytic leukemia (APL) is typically associated with bleeding, whereas thromboembolism (TE) is a less common cause of early death (ED) and frequently underestimated complication. To investigate the clinical characteristics and predictive risk factors for TE, we conducted this retrospective study. Our study included 306 patients diagnosed with APL at the Second Hospital of Shanxi Medical University between May 2012 and May 2023. Among them, 16(5.2%) patients (11 males and 5 females, with a median age of 58 years) experienced TE, including 13 cases of arterial TE (10 cerebral infarctions and three myocardial infarctions), one case of combined arterial and venous TE, and two cases of venous TE. Multivariate logistic regression analysis revealed age (OR 1.08, 95% CI 1.03-1.13, p = 0.001), smoking (3.26, 1.01-10.49, p = 0.048), alkaline phosphatase (ALP) > 125U/L (10.8, 2.26-51.46, p = 0.021), and serum creatinine (SCr) > 62µmol/L (7.09, 1.35-37.35, p = 0.003) as independent risk factors for TE in newly diagnosed APL patients. A nomogram incorporating the four aforementioned predictive factors demonstrated high accuracy and clinical applicability. With a median follow-up of 6.6 years (range: 0.6-11.8 years), the overall survival (OS) rate for all patients was 86.2%. When excluding patients who succumbed to ED, the OS rate increased to 96.2%. Importantly, there was no statistically significant difference in OS rates between non-ED patients with and without TE (p = 0.405). Our findings underscore that age, smoking, ALP, and SCr are four independent risk factors for TE in APL. Furthermore, TE primarily affects early survival but not OS rates in APL patients.