{
  "abstract": "Background: Transarterial chemoembolization (TACE) combined with PD-1 immune checkpoint inhibitor plus lenvatinib is a standard first-line therapy for unresectable hepatocellular carcinoma (HCC). Therapy-related acute promyelocytic leukemia (t-APL) is a rare but life-threatening secondary hematologic malignancy. Reports of t-APL following this triple regimen in non-HBV young female HCC patients remain extremely limited.\n\nMethods: We report a 30-year-old non-HBV female patient with moderately-differentiated HCC diagnosed incidentally in early pregnancy, who received pregnancy termination followed by oxaliplatin-fluorouracil-based TACE, then sintilimab plus lenvatinib maintenance. Clinical, laboratory, bone marrow, imaging and histopathological data were collected. We further performed a systematic review of published t-APL cases in HCC patients treated with targeted-immune therapy up to May 2026.\n\nResults: Approximately 12 months after treatment initiation, the patient developed oral mucosal ecchymosis, fatigue and anorexia. Serial blood tests demonstrated progressive thrombocytopenia and increasing circulating promyelocytes. Bone-marrow examination and FISH confirmed PML/RARA-positive t-APL. Due to economic burden, the patient refused standard all-trans retinoic acid (ATRA) plus arsenic trioxide and died 3 months after t-APL diagnosis. Combined with 11 previously reported cases (total n=12 globally), the median latency from targeted-immunotherapy commencement to t-APL onset was 11 months (range 6–18 months). Pathogenesis may involve synergistic genotoxic injury from TACE chemotherapy, PD-1-mediated immune dysregulation, lenvatinib-associated myelotoxicity and host individual susceptibility.\n\nConclusion: t-APL is a rare fatal complication of TACE plus sintilimab-lenvatinib for HCC, mostly occurring within 1 year of therapy initiation. Mandatory monthly hematologic monitoring is required during this high-risk window. Prompt bone-marrow evaluation and PML/RARA fusion testing should be performed for unexplained cytopenia or circulating immature myeloid cells to enable timely ATRA-arsenic-based intervention.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China",
    "Department of Oncology, The First People’s Hospital of Liangshan Yi Autonomous Prefecture, Liangshan, Sichuan, 615000, People’s Republic of China",
    "Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, 646000, People’s Republic of China",
    "Academician (Expert) Workstation of Sichuan Province, Luzhou, Sichuan, 646000, People’s Republic of China"
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Rong Yu"
    },
    {
      "affs": [
        0
      ],
      "name": "Xulin Shi"
    },
    {
      "affs": [
        0
      ],
      "name": "Huaxi Fan"
    },
    {
      "affs": [
        1
      ],
      "name": "Guishu Wu"
    },
    {
      "affs": [
        0
      ],
      "name": "Jing Zhang"
    },
    {
      "affs": [
        0
      ],
      "name": "Xiangyu Deng"
    },
    {
      "affs": [
        0
      ],
      "name": "Xiaolong Liu"
    },
    {
      "affs": [
        0
      ],
      "name": "Mingyue Rao"
    },
    {
      "affs": [
        0,
        2,
        3
      ],
      "name": "Jianwen Zhang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/14kjbttjtq09g.bib",
  "cited_by": 0,
  "doi": "10.2147/jhc.s656165",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13730098/",
  "id": "14kjbttjtq09g",
  "issns": [
    "2253-5969"
  ],
  "landing_url": "https://doi.org/10.2147/jhc.s656165",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Case Report"
    ],
    [
      "openalex",
      "1312|Retinoids in leukemia and cellular processes"
    ]
  ],
  "openalex": "W7224833685",
  "pdf_url": "https://www.dovepress.com/article/download/121615",
  "pmcid": "PMC13730098",
  "pmid": "42979222",
  "published": "2026-10-30",
  "publisher": "Dove Press",
  "ris": "https://research.draconitic.com/paper/14kjbttjtq09g.ris",
  "sources": [
    {
      "first_seen": "2026-11-07T12:22:43Z",
      "native_id": "PMC13730098",
      "source": "pmc",
      "url": "https://doi.org/10.2147/jhc.s656165"
    }
  ],
  "subjects": [
    {
      "field": "biochemistry",
      "origin": "openalex:1312|Retinoids in leukemia and cellular processes",
      "subfield": "molecular-biology"
    }
  ],
  "title": "Rare Case Report: Therapy-Related Acute Promyelocytic Leukemia (t-APL) in a Young Non-HBV Female After TACE Plus Sintilimab-Lenvatinib for HCC — A Clinical Alert and Literature Review",
  "title_text": "Rare Case Report: Therapy-Related Acute Promyelocytic Leukemia (t-APL) in a Young Non-HBV Female After TACE Plus Sintilimab-Lenvatinib for HCC — A Clinical Alert and Literature Review",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:22:43Z",
  "url": "https://research.draconitic.com/paper/14kjbttjtq09g",
  "venue": "Journal of Hepatocellular Carcinoma",
  "versions": []
}