Fig. 1: Prophylaxis and management for APL DS.

A Prophylaxis against APL DS. B Management for APL DS. ^aIf the WBC count exceeded 10 × 10⁹/L, 4-6 doses of IDA (2-5 mg/dose) were administrated 72 hours after initiation of ATRA in case of fatal bleeding risk. ^bAdministrated DXMS 10 mg twice daily promptly at the earliest symptom or sign suggestive of DS, such as dyspnea, unexplained fever, weight gain greater than 5 kg, unexplained hypotension, acute renal failure, pulmonary infiltrates, or pleuropericardial effusion. ^cPatients should be closely monitored. If the symptoms/signs did not improve within 24 hours or worsened in 8 hours (e.g., shortness of breath, slight hemoptysis, lower blood oxygen saturation, high-flow oxygen therapy requirement, and progressive oliguria), ruxolitinib should be initiated. ^dThe selection of different doses of ruxolitinib should be based on a comprehensive evaluation of the severity of DS, age, weight, general condition, and accompanying comorbidities. ^eThe details of aggressive supportive care are available in the Supplementary Appendix. WBC white blood cell, ATRA all-trans retinoic acid, HU hydroxyurea, DXMS dexamethasone, IDA idarubicin, DS differentiation syndrome.