Risk factors for disseminated intravascular coagulation in pediatric acute promyelocytic leukemia: Insights from the cclg-APL 2016 study

Abstract Purpose: To identify early risk factors for DIC, particularly severe DIC (grade 4-5), in pediatric APL, with the aim of guiding early clinical intervention. Methods: 186 pediatric APL patients enrolled in the CCLG-APL 2016 study across 38 hospitals nationwide were grouped based on the occurrence and severity of DIC during induction therapy. Results: 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 WBC≥5×109/L, initial PLT≤26×109/L, and ATO use (P<0.05). Multivariate analysis identified initial PLT ≤26×109/L (P=0.002, OR=2.679, 95% CI: 1.438-4.992) as an independent risk factor, while induction therapy using RIF was a protective factor (P=0.030, OR=0.465, 95%CI: 0.232-0.929). Patients with initial WBC≥55×109/L (P=0.014) were more likely to develop grade 4-5 DIC. Further analysis revealed that 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. Conclusion: Initial WBC≥5×109/L is 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 of DIC during induction therapy. Additionally, initial WBC≥55×109/L is related to grade 4-5 DIC. FLT3 mutation, PLT≤26×109/L, and initial bone marrow blasts ≥90% are independent risk factors for grade 4-5 DIC. This is the largest pediatric APL cohort to date specifically focused on DIC and offers comprehensive analyses that may inform future prospective studies.