Disseminated intravascular coagulation complicating acute lymphoblastic leukemia: A study of childhood and adult cases

Abstract

A high incidence of disseminated intravascular coagulation (DIC) in adult patients with acute lymphoblastic leukemia (ALL) is reported. However, studies comprising both childhood and adult patients are sparse and the clinical relevance of DIC in ALL patients has been a conflicting issue. Coagulation profiles at presentation and within seven days after starting remission-induction therapy of 44 childhood and 51 adult ALL patients were studied. At presentation, two childhood (5%) and 11 adult (22%) patients had DIC (p<0.05). After starting therapy, four of 27 childhood (15%) and 14 of 33 adult (42%) patients screened for coagulopathy developed DIC (p<0.05). Overall, six of the 44 children (14%) and 25 of the 51 adults (49%) were complicated with DIC (p<0.001). In the adult cases, DIC was more frequently complicated with FAB subtype L2 than L1 (p<0.05). All hemorrhages seen in the childhood cases were minor hemorrhages. In the adult patients, two patients with DIC had WHO grade 3 hemorrhage and the other hemorrhagic complications were minor hemorrhages. While milder induction therapies starting with corticosteroid given for childhood cases should be taken into consideration when comparing the incidences of DIC after therapy, the findings indicated that childhood and adult ALL may differ in the procoagulant characteristics. Morphological distinction between L1 and L2 appears to have relevance in the procoagulant activity in adult ALL. DIC complicating ALL is generally mild, however, sometimes causes severe hemorrhages in adults.

SIL-TAL1 Rearrangement is Related with Poor Outcome: A Study from a Chinese Institution

“…We discovered 11 patients with SIL-TAL1 developing overt DIC in different degrees according to the scoring system given by International Society on Thrombosis and Hemostasis (ISTH). In previous literatures, the DIC was found in about 10% of adult ALL patients, and less than 5% in childhood ALL [25], [26]. In our study, the incidence of DIC was much higher in patients carrying SIL-TAL1 , and most DIC accompanying with TLS occurred in the early stage of induction therapy, which indicated that DIC may also be related to the breaking down of leukemia cells during chemotherapy.…”

Disseminated intravascular coagulation in paediatrics

“…The incidence of DIC in this report was probably underestimated as paediatric ICU and emergency care patients were not included 1. The incidence of DIC in childhood acute lymphoblastic leukaemia and acute promyelocytic leukaemia (APML) were reported as 14%11 and 4%–8%,12 respectively.…”

Disseminated Intravascular Coagulation in Hematologic Malignancies

“…When available, data refer mostly to patients symptomatic for bleeding or thrombosis, and diagnostic criteria are largely heterogeneous (Table 1). 9,10,[26][27][28] These studies show that clinically overt DIC may be diagnosed in $15% of patients with acute leukemia, with a tendency to higher figures in AML than in ALL, and in adult patients than in children. Higher rates of patients show clinical and/or laboratory findings of DIC after starting treatment, consistent with the release of procoagulants and cytokines by leukemic cells damaged by chemotherapy.…”