Coagulopathy in cytogenetically and molecularly distinct acute leukemias at diagnosis: Comprehensive study

Guo, Zhiping; Chen, Xiuhua; Tan, Yanhong; Xu, Zhifang; Xu, Lianrong

doi:10.1016/j.bcmd.2019.102393

Cited by 14 publications

(19 citation statements)

References 35 publications

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“…8 The prevalence of DIC is highly variable in studies, partially due to the type of leukemia and different patient populations, and ranges from 8.5 to 25% of patients with non-APL AML or ALL, with another AE 15% of patients also developing DIC soon after the initiation of chemotherapy. [9][10][11][12] In children, DIC has been reported in 14% of cases of AML, in 3 to 14% in ALL, and between 17 and 100% in APL (based on a systematic review by Kongstad et al 13 ). Indeed, in APL, DIC is highly prevalent, with up to 90% of cases fulfilling DIC criteria.…”

Section: Prevalencementioning

confidence: 99%

“…11 In such patients, FMS-like tyrosine kinase 3 internal tandem duplication (FLT3-ITD) and nucleophosmin 1 (NMP1) status were independently associated with DIC in the multivariate analysis. 9 The mechanisms linking these mutations with determinants of DIC still need to be established. The clinical presentation is variable: hemorrhagic manifestations, including life-threatening bleeding, dominate in the majority of studies, but thromboembolic complications also occur frequently.…”

Section: Clinical Presentation and Associated Variablesmentioning

confidence: 99%

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Management of Disseminated Intravascular Coagulation in Acute Leukemias

Cate

Leader

2021

Hamostaseologie

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Disseminated intravascular coagulation (DIC) is characterized by the intravascular activation of coagulation with loss of localization arising from different causes, and is diagnosed using scoring systems which rely upon the presence of an underlying disorder compatible with DIC alongside hemostatic derangements such as low platelet count, prolonged prothrombin time, and elevated fibrinogen degradation products. DIC is common in patients with acute leukemia, with prevalence ranging from 17 to 100% in acute promyelocytic leukemia (APL) and 8.5 to 25% in acute lymphoblastic leukemia (ALL) and non-APL acute myeloid leukemia (AML). The pathophysiology is complex and varies between the leukemia subtypes, and is not fully reflected by the laboratory markers currently used to classify DIC. Similarly, the clinical consequence of DIC in acute leukemia also varies across the types of leukemia. DIC is primarily associated with bleeding in APL, while thrombosis is the dominant phenotype in ALL and non-APL AML. The cornerstone of managing DIC is the treatment of the underlying disease, as exemplified by the important role of early administration of all-trans retinoic acid in APL. Other aspects of management focus on supportive care aimed at minimizing the risk of bleeding, via transfusion of blood products. The use of blood products is more liberal in APL, due to the hemorrhagic phenotype and unacceptably high rates of early hemorrhagic death. This review will focus on the pathophysiology, risk factors, clinical implications, and the management of DIC in patients across the spectrum of acute leukemias.

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Section: Prevalencementioning

confidence: 99%

Section: Clinical Presentation and Associated Variablesmentioning

confidence: 99%

Management of Disseminated Intravascular Coagulation in Acute Leukemias

Cate

Leader

2021

Hamostaseologie

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“…Incidencija DIK-a u akutnim leukemijama je varijabilna. Najveća je kod APL-a, a najmanja kod B-ćelijske akutne limfoblastne leukemije [16]. Diseminovana intravaskularna koagulopatija je veoma ispitivana kod APL-a, ali su podaci o njenoj učestalosti i značaju u ne-APL AML-u veoma oskudni i raznoliki.…”

Section: Discussionunclassified

“…The International Society on Thrombosis and Hemostasis (ISTH) has recommended a scoring system, which is applied in patients with an underlying disorder, known to be linked to the development of DIC, where the following four laboratory parameters are monitored: platelet (thrombocyte) count (Tr), prothrombin time (PT), fibrinogen concentration, and the D-dimer level [12]. Disseminated intravascular coagulopathy is present in as many as 90% of the patients with APL [15], while the frequency of DIC in other types of AML is significantly lower, and ranges from 10% do 40% [16]. There are no studies analyzing the effect of the ISTH DIC on early mortality in patients with AML.…”

Section: Metodementioning

confidence: 99%

“…Međunarodno društvo za trombozu i hemostazu (ISTH -International Society on Thrombosis and Hemostasis) preporučilo je sistem bodovanja, koji se upotrebljava kod bolesnika koji imaju neki osnovni poremećaj, za koji se zna da je povezan sa razvojem DIK-a, i u kojem se prate četiri laboratorijska parametra: broj trombocita (Tr), protrombinsko vreme (PT), koncentracija fibrinogena, i nivo D-dimera [12]. Diseminovana intravaskularna koagulopatija je prisutna kod čak 90% bolesnika sa APL-om [15], dok je učestalost DIK-a kod ostalih tipova AML-a znatno manja, i kreće se od 10% do 40% [16]. Ne postoje studije koje su pratile uticaj vrednosti ISTH DIK skora na ranu smrt kod bolesnika sa AML-om.…”

Section: Introductionunclassified

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Disseminated intravascular coagulopathy in non-promyelocytic acute myeloid leukemia: Incidence, clinical and laboratory features and prognostic significance

Cvetković¹,

Mitrović²

2021

Srpski medicinski časopis Lekarske komore

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Introduction: Acute promyelocytic leukemia (APL) has the highest risk for overt disseminated intravascular coagulopathy (DIC), with reported incidence of DIC of up to 90%, as compared to 10-40% in other AML types. The influence of DIC on early death in non-APL AML patients has not been evaluated so far. Aim: The aim of our study was to analyze the incidence of DIC, its clinical and laboratory characteristics, and the impact on the survival and early death of patients with non-APL AML. Materials and methods: A total of 176 patients with non-APL AML, diagnosed and treated at the Clinic for Hematology of the Clinical Center of Serbia, between 2015 and 2020, were evaluated retrospectively. The diagnosis of DIC was made on the basis of ISTH (International Society on Thrombosis and Haemostasias) criteria. Results: The mean age of our patients was 53.8 ± 14.6 years, with 99/176 patients being men (56.2%). DIC was present in 74/176 patients (42.05%), who had a significant prevalence of the hemorrhagic syndrome (p = 0.01). The risk factors for overt DIC were the following: older age (p <0.01), comorbidities (p = 0.01), leukocytosis (p <0.001) and a high level of LDH (p <0.001). The FAB (French, American and British) type of non-APL AML, the cytogenetic risk group, and CD56 (cluster of differentiation) had no influence on overt DIC (p > 0.05). No difference was found in early mortality, outcome, and the survival of non-APL AML patients, with and without DIC (p > 0.05). Conclusion: Older age at diagnosis, comorbidities, leukocytosis, and high LDH concentrations are found to be adverse risk factors for overt DIC in non-APL AML patients. If treated promptly, with immediate, adequate and intensive use of blood derivates and components, DIC has no negative impact on early mortality, outcome, and survival.

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Preparing Your Patient for Chemotherapy

Zhang,

Rivero

2024

Consulting Hematology and Oncology Handbook

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Coagulopathy in cytogenetically and molecularly distinct acute leukemias at diagnosis: Comprehensive study

Cited by 14 publications

References 35 publications

Management of Disseminated Intravascular Coagulation in Acute Leukemias

Management of Disseminated Intravascular Coagulation in Acute Leukemias

Disseminated intravascular coagulopathy in non-promyelocytic acute myeloid leukemia: Incidence, clinical and laboratory features and prognostic significance

Preparing Your Patient for Chemotherapy

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