Objective：To summarize the major complications of acute promyelocytic leukemia in children and adolescents and to analyze the risk factors. Methods：Retrospective analysis was performed for children and adolescents with primary acute promyelocytic leukemia admitted to the First Affiliated Hospital of Nanjing Medical University from January 2010 to May 2021. The incidences of various complications were summarized. The risk factors for the occurrence of differentiation syndrome was evaluated with logistic multi- variate regression. Kaplan -Meier survival analysis was used to assesse the cumulative event -free survival(EFS)and overall survival (OS)of the patients. Results：In 43 patients with acute promyelocytic leukemia，the levels of serum ferritin，lactate dehydrogenase (LDH)，interleukin-6(IL-6)and albumin(ALB)in the differentiation syndrome group were significantly higher than those in the non-differentiation syndrome group(P ＜ 0.05). Multivariate logistic stepwise regression analysis showed that WBC_max，serum ferritin， LDH and IL-6 were significantly increased，which were independent risk factors for differentiation syndrome during induction treatment (P ＜ 0.01). There was no significant difference in cumulative OS rate and EFS rate between high - risk group and low - risk group. Conclusion：Various complications including bleeding and differentiation syndrome may be observed during the initial period and duration of therapy for acute promyelocytic leukemia in children and adolescents. Excessive increases of leukocyte count and inflammatory factors such as LDH，serum ferritin and IL-6 after retinoic acid induction therapy are the risk factors for the occurrence of differentiation syndrome.