Risk factors for DIC in paediatric APL: Insights from the CCLG‐APL 2016 study

To identify early risk factors for disseminated intravascular coagulation (DIC), particularly severe DIC (grade 4-5), in paediatric acute promyelocytic leukaemia (APL). One hundred and eighty-six paediatric APL patients enrolled in the Chinese Children Leukemia Group (CCLG)-APL 2016 study across 38 hospitals nationwide were grouped based on the occurrence and severity of DIC during induction therapy. DIC occurred in 52.2% of patients during induction therapy, with 7.5% developing grade 4-5 DIC. Significant differences were observed between the DIC and non-DIC groups in the proportion of patients with initial white blood cells (WBC) ≥5 × 10⁹/L, initial platelets (PLT) ≤26 × 10⁹/L and arsenic trioxide (ATO) use (p < 0.05). Multivariate analysis identified initial PLT ≤26 × 10⁹/L (p = 0.002, odds ratio [OR] = 2.679, 95% confidence interval [CI]: 1.438-4.992) as an independent risk factor, while induction therapy using realgar-indigo naturalis formula (RIF) was a protective factor (p = 0.030, OR = 0.465, 95% CI: 0.232-0.929). Further analysis revealed that Fms-like tyrosine kinase 3 (FLT3) mutation (p = 0.023, OR = 11.742, 95% CI: 1.405-98.149), initial PLT ≤26 × 10⁹/L (p = 0.017, OR = 13.784, 95% CI: 1.598-118.905) and initial bone marrow blasts ≥90% (p = 0.030, OR = 5.289, 95% CI: 1.178-23.744) were significant risk factors for grade 4-5 DIC. Initial WBC ≥5 × 10⁹/L and PLT ≤26 × 10⁹/L are associated with an increased risk of DIC, with PLT ≤26 × 10⁹/L as an independent risk factor. Compared with ATO, RIF is a protective factor during induction therapy. Additionally, FLT3 mutation, PLT ≤26 × 10⁹/L and initial bone marrow blasts ≥90% are independent risk factors for grade 4-5 DIC.