APL with Sanz high risk — WBC >10 ×10^9/L at diagnosis — supports ATRA+ATO+idarubicin (or...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-SANZ-HIGH-RISK`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-APL`
Sources	`SRC-ELN-APL-2019` `SRC-NCCN-AML-2025`

Red Flag Origin

Definition	APL with Sanz high risk — WBC >10 ×10^9/L at diagnosis — supports ATRA+ATO+idarubicin (or +gemtuzumab in selected protocols); higher early-death risk and warrants leukapheresis-avoidance + aggressive DIC management
Clinical direction	intensify
Category	risk-score
Shifts algorithm	ALGO-APL-1L

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">",
      "finding": "wbc_count_x10_9_per_l",
      "threshold": 10
    },
    {
      "finding": "apl_sanz_risk",
      "value": "high"
    }
  ],
  "type": "composite_score"
}

Notes

High-risk APL (WBC >10) carries 10-15% early-death risk, primarily from DIC + differentiation syndrome. Standard 1L is ATRA + ATO + idarubicin (or with gemtuzumab in some North American protocols replacing idarubicin in cardiac patients). APML4 / AIDA / Lo-Coco data support triplet over doublet for high-risk. NCCN AML 2025 / ELN APL 2019. Leukapheresis is contraindicated (worsens DIC); use ATRA + hydroxyurea for cytoreduction. Severity `critical` because intensification + DIC bundle is mandatory, not preference.

Used By

Algorithms

ALGO-APL-1L - ALGO-APL-1L