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The very early death of a newly diagnosed acute leukemia (AL) patient is very frustrating, and there are very few published works (except for the case of acute promyelocitic leukemia, APL) analyzing this circumstance and the features of these patients.

Our objective was to study the main characteristics of patients with acute leukemia who died within the first 96 hours after diagnosis in our centre in the last 15 years.

We studied all cases of acute leukemia diagnosed in our institution between April 2002 and January 2017, focusing on the analysis of those who died within the first 96 hours after diagnosis. In this subset of patients, we collected data concerning clinical presentation, hemogram, biochemical parameters, coagulation status, performance of a bone marrow aspirate, acute leukemia subtype, started therapy, initiation or not of induction chemotherapy, time elapsed from diagnosis to death (hours), and cause of death, among others.

A total of 346 consecutive cases of acute leukemia were recorded in this period of time: 222 of acute myeloid leukemia (AML, 64%) and 124 of acute lymphoblastic leukemia (ALL, 36%). Thirty-three patients were diagnosed of acute promyelocytic leukemia (15% of all AML). Those patients who died in the first four days after the diagnosis were only seven (2%), with a median of 45 hours of life (range 21-96). Main clinical and analytical findings are shown in the Table 1. They were 5 men and 2 women with a median of 57 years (range 22-91). Two of the seven patients had an APL (6% of all diagnosed APL). All patients showed leukocytosis, but hyperleukocytosis was only recorded in 2/7 patients, and severe thrombocytopenia (Plt ≤ 20 x10⁹/L) in 3/7. There was possibility of bone marrow aspiration only in 4/7 cases. Coagulopathy was detected in four of six patients, including criteria for disseminated intravascular coagulation (DIC) in three cases. The exitus took place in the Intensive Care Unit in 5 cases, while it occurred in the Hematology facility in two.

In our experience, about 2% of patients with acute leukemia die within the first 96 hours after diagnosis (including 6% of APL). Clinical and analytical feautures of this subset of patients are very heterogeneous, although AML clearly predominate on ALL. More extensive and multicenter studies are needed to deepen into the circumstances conditioning this early fatal course of the disease.