Original Articles
Vol. 18 No. 1 (2026): Mediterranean Journal of Hematology and Infectious Diseases
ASSOCIATION OF BASELINE PLATELET COUNT WITH COMPLETE REMISSION, SEVERE BLEEDING, AND 24-MONTH OVERALL SURVIVAL IN PATIENTS WITH NEWLY DIAGNOSED ACUTE MYELOID LEUKEMIA: A SINGLE-CENTER RETROSPECTIVE COHORT STUDY
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: September 1, 2026
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Objective: To investigate the association between baseline platelet count at diagnosis and complete remission (CR) rate, severe bleeding, and overall survival (OS) in newly diagnosed acute myeloid leukemia (AML).
Methods: This single-center retrospective cohort study enrolled 356 non-acute promyelocytic leukemia (non-APL) AML patients treated with first-line therapy between January 2020 and December 2025. Patients were classified as having a low baseline platelet count (<50 × 10⁹/L, n=218) or a normal/high count (≥50 × 10⁹/L, n=138). The primary outcomes were severe bleeding (CTCAE grade ≥3) and overall survival administratively censored at 24 months. Parsimonious multivariable Logistic and Cox models, Kaplan–Meier analysis, 1:1 propensity score matching (PSM), continuous platelet modeling, restricted cubic splines (RCS), and alternative-threshold analyses were used.
Results: CR (53.7% vs. 50.7%, P=0.665) and CR/CRi rates (63.3% vs. 68.8%, P=0.339) did not differ significantly between groups. Severe bleeding was more frequent in the low-platelet group (22.5% vs. 8.7%, P=0.001), and low baseline platelet count remained associated with severe bleeding after parsimonious adjustment (OR=3.124, 95% CI 1.447–6.746, P=0.004). Kaplan–Meier analysis showed lower 24-month OS in the low-platelet group (58.2% vs. 77.8%; log-rank P<0.001), and the adjusted 24-month Cox model yielded an HR of 1.843 (95% CI 1.167–2.910, P=0.009). Per 10 × 10⁹/L higher baseline platelet count, the adjusted odds of severe bleeding were 24.2% lower and the 24-month death hazard was 11.4% lower. RCS analyses found no statistically significant departure from linearity. In the PSM sensitivity analysis, which retained residual covariate imbalance, the 24-month OS estimate remained significant (HR=1.981, 95% CI 1.228–3.193, P=0.005), whereas the severe-bleeding association was not confirmed (OR=2.286, 95% CI 0.940–5.556, P=0.068).
Conclusion: A baseline platelet count <50 × 10⁹/L was associated with severe bleeding and lower 24-month OS, but not with induction CR, in this retrospective AML cohort. This study did not assess incremental predictive value beyond established AML risk systems; the findings should therefore be considered hypothesis-generating and require prospective external validation.
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Ethics Approval
Acute Myeloid Leukemia Research, Platelet Disorders and Treatments, Leukemia, Retrospective Cohort Study, Overall Survival, Hemorrhage / BleedingSupporting Agencies
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.How to Cite
“ASSOCIATION OF BASELINE PLATELET COUNT WITH COMPLETE REMISSION, SEVERE BLEEDING, AND 24-MONTH OVERALL SURVIVAL IN PATIENTS WITH NEWLY DIAGNOSED ACUTE MYELOID LEUKEMIA: A SINGLE-CENTER RETROSPECTIVE COHORT STUDY” (2026) Mediterranean Journal of Hematology and Infectious Diseases, 18(1), p. e2026071. doi:10.4084/MJHID.2026.071.
Copyright (c) 2026 Tao Zhou, Zengfeng Ni, Wenjing Fan, Jing Xu, Jing Qin, Kaiyue Wang, Rui Wang, Yaping Li
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