Predictive factors for differentiating thrombohemorrhagic disorders in high-risk acute promyelocytic leukemia. Issue 210 (February 2022)

• Record Type: Journal Article
• Authors: Xiao, Mengyu; Zhou, Pan; Liu, Yanhui; Wei, Shengjie; Li, Dan; Li, Weiya; Niu, Xiaona; Niu, Junwei; Zhang, Yinyin; Cao, Weijie; Liu, Bing; Wang, Xiaojiao; Bai, Yanliang; Sun, Kai
• Is Part Of: Thrombosis research. Issue 210(2022)
• Page Start: 33
• Page End: 41
• Publication Date: 2022-02
• Subjects: F female -- M male -- WBC white blood cell -- HGB hemoglobin -- PLT platelets -- PT prothrombin time -- APTT activated partial thromboplastin time -- FIB fibrinogen -- FDP fibrinogen degradation products -- CR complete remission -- NA not available -- DIC disseminated intravascular coagulation -- ATRA all-trans retinoic acid -- ATO arsenic trioxide -- LDH lactate dehydrogenase -- DS differentiation syndrome -- ED early death -- HED hemorrhage-related ED -- TH-ED thrombohemorrhagic early death -- WHO World Health Organization -- HR hazard ratio -- CI confidence interval -- BMI body mass index -- ECOG Eastern Cooperative Oncology Group -- CDSS Chinese Society of Thrombosis and Hemostasis scoring system for DIC; Acute promyelocytic leukemia -- High-risk -- Severe bleeding -- Thrombosis -- WBC/D-dimer -- Disseminated intravascular coagulation; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2021.12.020
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Introduction: Acute promyelocytic leukemia (APL) is often accompanied by potentially fatal coagulopathy, especially in high-risk APL. Bleeding, particularly severe bleeding is the leading cause of early death (ED). Meanwhile, thrombosis, the other major coagulopathic complication, is being increasingly recognized. However, predictors of thrombohemorrhagic disorders are still not well investigated. Materials and methods: In this study, we retrospectively studied 83 patients with high-risk APL and categorized them into severe bleeding, thrombosis and no evident events groups. Results: Severe bleeding was observed in 15 patients, nearly half of whom died of hemorrhage, while thrombosis was observed in 12 patients. Risk factor analysis showed that high WBC (>58.76 × 10 9 /L) ( p = 0.001) and prolonged PT (>17.7 s) (p = 0.015) could be independent predictors for severe bleeding, while high WBC/D-dimer>5.12 (p = 0.002) and low D-dimer/FIB<5.14 (p = 0.03) could be independent predictors for thrombosis in high-risk APL patients. Moreover, there are significant differences in WBC/D-dimer and D-dimer/FIB between DIC and Non-DIC groups (p < 0.001). Notably, we found that the WBC/D-dimer was dramatically higher in the thrombotic group than in the other two groups at the time of admission or during the first week of induction therapy. Conclusions: High WBC and prolonged PT could predict severe bleeding in high-risk APL patients, while high WBC/D-dimer and low D-dimer/FIB could be independent predictors for thrombosis. For high-risk APL, WBC/D-dimer and D-dimer/FIB are also beneficial in the diagnosis of DIC. WBC/D-dimer might help early identification of thrombosis at the time of admission or during the first week of induction therapy. Highlights: High WBC and prolonged PT could predict severe bleeding in high-risk APL patients. WBC/D-dimer and D-dimer/FIB can be beneficial for early identification of thrombosis and the diagnosis of DIC. PT, D-dimer, FDP/FIB, D-dimer/FIB and WBC/D-dimer could differentiate severe hemorrhage from thrombosis. WBC/D-dimer might help early identification of thrombosis at admission or during the first week of induction therapy.