Frequency and risk factors for thrombosis in acute myeloid leukemia and high-risk myelodysplastic syndromes treated with intensive chemotherapy: a two centers observational study

Martella, Federica; Cerrano, Marco; Cuonzo, Daniela Di; Secreto, Carolina; Olivi, Matteo; Apolito, Vincenzo; D’Ardia, Stefano; Frairia, Chiara; Giai, Valentina; Lanzarone, Giuseppe; Urbino, Irene; Freilone, Roberto; Giaccone, Luisa; Busca, Alessandro; Dellacasa, Chiara Maria; Audisio, Ernesta; Ferrero, Dario; Beggiato, Eloise

doi:10.1007/s00277-022-04770-6

Cited by 27 publications

(37 citation statements)

References 71 publications

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“…Such a cut-off is not optimal to quantify the risk of thrombosis in AML patients since the very frequent baseline condition of thrombocytopenia precludes its applicability. Studies specifically focused on patients with acute leukemias [ 17 , 34 ] found that a baseline PLTc > 50 × 10 9 /L was an independent risk factor for VTE development. Given the propensity of AML to trigger coagulopathy, Libourel et al [ 16 ] evaluated the role of the ISTH-DIC score [ 39 ] to predict the risk of thrombosis in AML patients.…”

Section: Discussionmentioning

confidence: 99%

“…For these reasons, inherently linked to the nature of the disease and to its treatment, the ISTH-DIC score fails to reliably predict risk of VTE development in AML. While Libourel showed that the occurrence of TE was significantly higher in patients with laboratory evidence of DIC (DIC score ≥ 5) prior to the initiation of treatment, other studies confirmed the limitation of ISTH-DIC score in VTE-prediction in AML patients [ 17 ]. Our study did not show a significant association between VTE and ISTH DIC score.…”

Section: Discussionmentioning

confidence: 99%

“…Available information about thrombosis in non-promyelocytic acute myeloid leukemia (AML) is scarce, with a reported incidence of TE ranging from 2% to 13% [ 14 , 15 , 16 , 17 ]. In such a scenario, the pathogenesis of TE is multifactorial with leukemia cells exerting a prothrombotic effect through the release of fibrinolytic and proteolytic factors, inflammatory cytokines and over-expression of tissue factor on the cell surface of leukemic cells [ 18 , 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Early Thrombotic Events in Adult Patients with Acute Myeloid Leukemia: A Real-World Experience

Paterno

Palmieri

Forte

et al. 2022

Cancers

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Information regarding the incidence and the prognostic impact of thrombotic events (TE) in non-promyelocytic acute myeloid leukemia (AML) is sparse. Although several risk factors associated with an increased risk of TE development have been recognized, we still lack universally approved guidelines for identification and management of these complications. We retrospectively analyzed 300 consecutive patients with newly diagnosed AML. Reporting the incidence of venous TE (VTE) and arterial TE (ATE) was the primary endpoint. Secondarily, we evaluated baseline patient- and disease-related characteristics with a possible influence of VTE-occurrence probability. Finally, we evaluated the impact of TE on survival. Overall, the VTE incidence was 12.3% and ATE incidence was 2.3%. We identified three independent predictors associated with early-VTE: comorbidities (p = 0.006), platelets count >50 × 109/L (p = 0.006), and a previous history of VTE (p = 0.003). Assigning 1 point to each variable, we observed an overall cumulative incidence of VTE of 18.4% in the high-risk group (≥2 points) versus 6.4% in the low-risk group (0–1 point), log-rank = 0.002. Overall, ATE, but not VTE, was associated with poor prognosis (p < 0.001). In conclusion, TE incidence in AML patients is not negligible. We proposed an early-VTE risk score that could be useful for a proper management of VTE prophylaxis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Predictors of Early Thrombotic Events in Adult Patients with Acute Myeloid Leukemia: A Real-World Experience

Paterno

Palmieri

Forte

et al. 2022

Cancers

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“…Please see ►Table 1 and ►Table 2 for an overview of the results on solid cancers and mixed cancers, respectively, and ►Table 3 for hematological cancers. Studies included patients with solid cancers (n ¼ 61), 14, hematological malignancies (n ¼ 17), [86][87][88][89][90][91][92][93][94][95][96][97][98][99][100][101][102] or both (n ¼ 22). 7, There were two meta-analyses, 55,63 eight case-control studies, 34,58,62,69,82,104,117,120 one randomized controlled trial, 113 and 89 cohort studies, 7,14,26-33,35-54 56,57,59-61,64-68,70-81,83-103,105-116,118,119,121-123 among which data were collected prospectively in 36 studies, 7,14,33,36,38-40,42-44,46-48,52,57,60,61,70,71,73,74,77,78,80 81,87,88,93,96 105,107,112,114,118 119,121 and obtained retrospectively from medical records in 53 studies.…”

Section: Resultsmentioning

confidence: 99%

Platelet Parameters as Biomarkers for Thrombosis Risk in Cancer: A Systematic Review and Meta-analysis

Malte

Højbjerg

Larsen

2023

Semin Thromb Hemost

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Cancer-associated thrombosis (CAT) is a major cause of both morbidity and mortality in cancer patients. Platelet count has been investigated as a predictor of CAT in various settings while knowledge on platelet activation parameters is sparse. This report provides a systematic review and meta-analysis on available literature on associations between platelet count and/or function and arterial and venous thrombosis in adult cancer patients. The review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. PubMed and Embase were searched up to March 2022. The National Heart, Lung, and Blood Institute's tools were used for quality assessment. In total, 100 studies were included which investigated the association between CAT and platelet count (n = 90), platelet indices (n = 19), and platelet function/activation markers (n = 13) in patients with solid cancers (n = 61), hematological cancers (n = 17), or mixed cancer types (n = 22). Eighty-one studies had venous thrombosis as their outcome measure, while 4 had arterial thrombosis and 15 studies had both. We found significantly elevated odds ratio of 1.50 (95% confidence interval: 1.19–1.88) for thrombosis with higher platelet counts. We saw a tendency toward an association between markers of platelet activation in forms of mean platelet volume and soluble P selectin and both arterial and venous thrombosis. Only one study investigated dynamic platelet function using flow cytometry. In conclusion, platelet count is associated with CAT across different cancer types and settings. Platelet function or activation marker analysis may be valuable in assisting thrombosis risk assessment in cancer patients but is sparsely investigated so far.

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“…Three included studies, encompassing 934 patients, reported on the prevalence of VTE in blood cancer patients [ 85 , 107 , 117 ]. However, a meta-analysis could not be performed due to insufficient number of studies.…”

Section: Resultsmentioning

confidence: 99%

Venous Thromboembolism in Cancer Patients Undergoing Chemotherapy: A Systematic Review and Meta-Analysis

Sun

Bhaskar

2022

Diagnostics

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Objective: Venous thromboembolism (VTE) is a life-threatening complication that may exacerbate cancer prognosis. Whilst some studies indicate an increased risk of VTE in cancer patients undergoing chemotherapy, the prevalence estimates on the pooled prevalence of VTE in cancer patients undergoing chemotherapy are not known. This study aims to calculate the pooled prevalence of VTE in chemotherapy-treated cancer patients. Methods: Studies on VTE occurrence in cancer patients undergoing chemotherapy were retrieved after database search. The terms used included “cancer”, “chemotherapy”, and “venous thromboembolism”. A random-effects meta-analysis was conducted to obtain a pooled estimate of VTE prevalence in cancer patients undergoing chemotherapy. Results: A total of 102 eligible studies involving 30, 671 patients (1773 with VTE, 28, 898 without) were included in the meta-analysis. The pooled estimate of VTE prevalence was found to be 6%, ranging from 6 to 7% (ES 6%; 95% CI 6–7%; z = 18.53; p < 0.001). Conclusions: The estimated pooled prevalence rate of VTEs was 6% in cancer patients undergoing CRT, which was higher than the overall crude prevalence rate (5.78%). Comprehensive cancer care should consider stratified VTE risk assessment based on cancer phenotype, given that certain phenotypes of cancer such as bladder, gastric and ovarian posing particularly high risks of VTE.

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Frequency and risk factors for thrombosis in acute myeloid leukemia and high-risk myelodysplastic syndromes treated with intensive chemotherapy: a two centers observational study

Cited by 27 publications

References 71 publications

Predictors of Early Thrombotic Events in Adult Patients with Acute Myeloid Leukemia: A Real-World Experience

Predictors of Early Thrombotic Events in Adult Patients with Acute Myeloid Leukemia: A Real-World Experience

Platelet Parameters as Biomarkers for Thrombosis Risk in Cancer: A Systematic Review and Meta-analysis

Venous Thromboembolism in Cancer Patients Undergoing Chemotherapy: A Systematic Review and Meta-Analysis

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