Early death (ED) occurs in 10-30% of patients with acute promyelocytic leukemia (APL). Is all- trans retinoic acid (ATRA) promptly given and does it decrease overall early mortality? ATRA was administered within 24. h of morphological suspicion in only 44% of the 120 consecutive patients treated in the four collaborating centers. Absence of disseminated intravascular coagulation (p= 0.012) and admission to a non-university-affiliated hospital (p= 0.032) were independent predictors of ATRA delay. ED occurred in 17% of patients, and was independently correlated only with ICU admission (p= 0.002). Our results do not demonstrate that prompt (versus delayed) ATRA administration decreases overall early death.