全反式维A酸（ATRA）联合蒽环类药物的引入显着改善了急性早幼粒细胞白血病（APL）患者的预后，并且该策略仍然是无法负担三氧化二砷的国家的护理标准。然而，来自国家登记处和现实世界数据库的数据表明，低收入和中等收入国家（LMIC）仍然面临令人失望的结果，这主要是由于高引产死亡率和并发症管理欠佳。美国血液学会成立了国际急性白血病联盟 (ICAL)，通过国际临床网络应对这一挑战。在此，我们介绍 ICAPL 研究的结果，该研究涉及巴西、智利、巴拉圭、秘鲁和乌拉圭招募的 806 名 APL 患者。与 ICAL 前 32% 的死亡率相比，诱导死亡率已降至 14.6%。多变量逻辑回归分析揭示了与诱导死亡相关的因素：年龄 ≥ 40 岁、ECOG = 3、基于 PETHEMA/GIMEMA 分类的高危状态、白蛋白水平 ≤ 3.5 g/dL、bcr3 PML/RARA 亚型、之间的间隔从出现症状到诊断超过48小时，并出现中枢神经系统和肺部出血。中位随访53个月，预计4年总生存（OS）率为81%，4年无病生存（DFS）率为80%，4年累积复发率(CIR) 率为 15%。这些结果与在高收入国家进行的研究中观察到的结果相似，强调了发展临床网络以改善中低收入国家临床护理和基础设施的长期有效性。版权所有 © 2024 美国血液学会。

The introduction of all-trans retinoic acid (ATRA) combined with anthracyclines has significantly improved the outcomes for patients with acute promyelocytic leukemia (APL), and this strategy remains the standard of care in countries where arsenic trioxide is not affordable. However, data from national registries and real-world databases indicate that low- and middle-income countries (LMIC) still face disappointing results, mainly due to high induction mortality and suboptimal management of complications. The American Society of Hematology established the International Consortium on Acute Leukemias (ICAL) to address this challenge through international clinical networking. Here, we present the findings from the ICAPL study involving 806 patients with APL recruited in Brazil, Chile, Paraguay, Peru, and Uruguay. The induction mortality rate has decreased to 14.6% compared to the pre-ICAL rate of 32%. Multivariable logistic regression analysis revealed as factors associated with induction death: age ≥ 40 years, ECOG = 3, high-risk status based on the PETHEMA/GIMEMA classification, albumin level ≤ 3.5 g/dL, bcr3 PML/RARA isoform, the interval between presenting symptoms to diagnosis exceeding 48 hours, and the occurrence of central nervous system and pulmonary bleeding. With a median follow-up of 53 months, the estimated 4-year overall survival (OS) rate is 81%, the 4-year disease-free survival (DFS) rate is 80%, and the 4-year cumulative incidence of relapse (CIR) rate is 15%. These results parallel those observed in studies conducted in high-income countries, highlighting the long-term effectiveness of developing clinical networks to improve clinical care and infrastructure in LMIC.Copyright © 2024 American Society of Hematology.