Abstract / Summary
Abstract: Acute promyelocytic leukemia (APL) is a highly curable subtype of acute myeloid leukemia since the introduction of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO), yet Middle Eastern data are limited. We report, to our knowledge, the first national APL cohort from the Arabian Gulf, leveraging centralized referral pathways in Kuwait to characterize incidence, presentation, treatment, and early mortality. We retrospectively analyzed all 75 patients diagnosed with APL in Kuwait between January 2010 and December 2025. Median age was 42 years (range, 24-77); 60% patients were male and 82.7% non-Kuwaiti, reflecting national demographics. Crude annual incidence was 1.09 per million. Bleeding was the most common presenting feature (66.7%), followed by infection (44%) and anemia (36%); 4 (5.3%) presented with life-threatening pulmonary or central nervous system hemorrhage. By Sanz/PETHEMA (Programa Español de Tratamientos en Hematología) criteria, 23 (30.7%) were high risk. Sixty-seven (89.3%) received standard APL-specific induction. Among these, 64 (95.5%) achieved complete remission. During induction, 41.8% developed differentiation syndrome, and 44.8% had significant infections. Overall, 7 (9.3%) died within 30 days; 5 deaths occurred before disease-specific therapy and 2 occurred during induction. At a median follow-up of 40 months, 5-year overall survival and leukemia-free survival were both 90.4%. One late relapse occurred at 113 months. Long-term outcomes in Kuwait approach major contemporary and large Asian series, whereas early mortality before treatment remains the principal barrier to cure.