APL with Sanz low risk — WBC ≤10 ×10^9/L AND platelets >40 ×10^9/L — supports ATRA+ATO ch...

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

ID	`RF-SANZ-LOW-RISK`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-APL`
Sources	`SRC-APL0406-LOCOCO-2013` `SRC-ELN-APL-2019` `SRC-NCCN-AML-2025`

Red Flag Origin

Definition	APL with Sanz low risk — WBC ≤10 ×10^9/L AND platelets >40 ×10^9/L — supports ATRA+ATO chemo-free induction/consolidation per APL0406 / Lo-Coco; no anthracycline indicated
Clinical direction	de-escalate
Category	risk-score
Shifts algorithm	ALGO-APL-1L

Trigger Logic

{
  "all_of": [
    {
      "comparator": "<=",
      "finding": "wbc_count_x10_9_per_l",
      "threshold": 10
    },
    {
      "comparator": ">",
      "finding": "platelet_count_x10_9_per_l",
      "threshold": 40
    }
  ],
  "type": "composite_score"
}

Notes

Sanz score (Sanz et al. Blood 2000) stratifies APL by presenting WBC and platelets: low = WBC ≤10 + plt >40, intermediate = WBC ≤10 + plt ≤40, high = WBC >10. APL0406 (Lo-Coco 2013, NEJM) randomized low/intermediate-risk patients to ATRA+ATO vs ATRA+chemo and showed non-inferior EFS plus reduced toxicity for ATRA+ATO. The chemo-free arm is now the standard of care for non-high-risk APL (NCCN AML 2025, ELN APL 2019). de-escalate direction reflects the avoidance of anthracycline-based consolidation.

Used By

Algorithms

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