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The emphasis of acute promyelocytic leukemia (APL) treatment has now shifted to limiting complications and decreasing early deaths.Some rare and severe complications need be earlier diagnosis and timely treatment to reduce the mortality.Here we report 4 patients who developed rapid diffuse alveolar hemorrhage (DAH) ALL APL patients were diagnosed due to the presence of the typical fusion gene PML-RARa and translocation t(15;17).Pulmonary infection both existed in these four patients.All-trans-retinoic acid (ATRA) and antibiotic were used at the time of diagnosis.