Hemorrhagic complications and outcomes of children with acute promyelocytic leukemia at initial hospital admission: a multicenter cohort study

Acute promyelocytic leukemia (APL) is an uncommon subtype of acute myeloid leukemia that is associated with hemorrhagic complications and early death. Our primary objective was to describe the frequency of hemorrhagic complications and outcomes associated with APL during the initial admission using the Pediatric Health Information System (PHIS) database. We performed a retrospective cross-sectional analysis of children with APL not in remission. Demographic characteristics, resource utilization, and outcomes were compared between those with and without hemorrhagic complications. Out of 173 patients with APL, hemorrhagic complications (intracranial, gastrointestinal, or pulmonary) occurred in 32%. Children with hemorrhagic complications were more likely to have acute respiratory failure, coagulopathy, stroke, and cerebral edema. Children with hemorrhagic complications experienced more ICU admissions and mechanical ventilation, and they also received transfusions, low molecular weight heparin, hydroxyurea, and rasburicase more frequently. The median length of stay and mortality rate was not different between the groups. The median length of stay of children who died was significantly lower (<i>p</i> = 0.003) as the majority (78%) who died death occurred within 7 days. Hemorrhagic complications occurred in a 3^rd of patients with the initial admission of APL, and most deaths occurred during the first week.