Understanding risk stratification in Acute Promyelocytic leukemia

A 26-year-old woman presented to the emergency room with a history of fatigue, fevers, and mild nasal bleeding for the past three days. Her per past medical history was unremarkable. Physical examination revealed a young woman with pallor, ecchymosis and gingival bleeding. Systemic examination was unremarkable. Complete blood count showed white blood cell (WBC) count 8000/microL, haemoglobin 9.4g/dl, and platelet count 41,000/µl. The WBC differential showed 21% lymphocytes, 17% monocytes, 7% eosinophils, and 55% other cells. Her coagulation parameters were normal. The patient was admitted for detail evaluation and treatment for bleeding. She underwent a bone marrow examination which confirmed presence of 60% abnormal promyelocytes on smear. Flow cytometry also confirmed an APML. Subsequent FISH analysis showed a t(15;17) translocation. Additional cytogenetic abnormality seen was FLT3-ITD [Fms-like tyrosine kinase-3 receptor] gene mutation. Based on these findings a diagnosis of APL was made.


Which of the following prognostic categories does this patient fall in?