Macular Haemorrhage in Adult Acute Leukaemia Patients at Presentation and the Risk of Subsequent Intracranial Haemorrhage

Jackson, Nancy Ewald; Reddy, Sagili Chandrasekhara; Harun, Mohd Hishamuddin; Quah, S. H.; Low, Heng Chin

doi:10.1046/j.1365-2141.1997.1833000.x

Cited by 25 publications

(13 citation statements)

References 5 publications

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“…Karesh et al [5] also found no difference in CR rate between patients with and those without retinopathy. One possibility is that LR may correlate with a higher incidence of fatal complications, and it is known that there is a higher incidence of intracranial hemorrhage within the first 30 days after diagnosis in those with MH [4]. However, even after CR is obtained, the current study shows that LR and IRH still have a significant poor prognostic implication on survival, though the numbers analyzable at that stage are small.…”

Section: Discussioncontrasting

confidence: 66%

“…MH was defined as any hemorrhage impinging upon the macula, i.e., an area the size of the optic disc, including the foveola, fovea, parafovea, and perifovea situated two disc diameters temporal to [4]. Leukemic retinopathy (LR) is defined for the purposes of this study as the presence of at least one of these retinal abnormalities.…”

Section: Methodsmentioning

confidence: 99%

“…However, one recent study showed that the presence of leukemic retinopathy had no effect on achievement of complete remission [5]. We have demonstrated that the presence of hemorrhages in the macular region of the retina is associated with a fivefold risk of intracranial hemorrhage in the first 30 days after diagnosis [4]. This study now looks at the complete remission rates and the duration of overall survival of our adult acute leukemia patients in relation to their retinal findings at presentation.…”

Section: Introductionmentioning

confidence: 92%

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Prognostic significance of retinopathy at presentation in adult acute leukemia

Reddy

Quah

Low

et al. 1998

Annals of Hematology

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Retinal changes are common in adult acute leukemia patients at presentation, but their prognostic significance is controversial. A 5-year study has been carried out with newly diagnosed acute leukemia patients aged 12-77 years. Seventy-seven cases (49 AML, 28 ALL) were studied prospectively for the presence of intraretinal hemorrhages (IRH), white-centered hemorrhages, cotton-wool spots, and macular hemorrhages. They were treated according to standard chemotherapy protocols, and then achievement of complete remission (CR) and the duration of overall survival (OS) were compared between the groups with and without these different retinal features. No association was found between the presence of any retinal abnormality and CR induction rate, although there was a trend to a lower CR rate among patients with IRH. The median OS of those with IRH was 72 days, compared with 345 days among those without IRH (p=0.002). A WBC at presentation greater than 50x10(9)/l and age greater than 40 years were also associated with shorter OS (p<0.0001 and p=0.0045, respectively). However, after regression analysis, IRH remained statistically significant as a poor prognostic indicator (p=0.01). We conclude that the presence of IRH is an indicator of poor prognosis in acute leukemia.

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Section: Discussioncontrasting

confidence: 66%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 92%

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Prognostic significance of retinopathy at presentation in adult acute leukemia

Reddy

Quah

Low

et al. 1998

Annals of Hematology

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“…Several studies have implicated anemia, thrombocytopenia or leukocytosis in the pathogenesis of leukemic retinopathy [1, 2, 17, 18, 19], but other reports showed no association between fundus oculi findings and laboratory parameters [20, 21, 22, 23, 24]. Our report considers RA in adult AML and is the first to distinguish between two age-related groups of patients when assessing their role as prognostic factor.…”

Section: Discussionmentioning

confidence: 97%

Retinal Abnormalities in Newly Diagnosed Adult Acute Myeloid Leukemia

et al. 2001

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Retinal abnormalities (RA) are very frequently observed in adult patients with acute myeloid leukemia (AML), but the clinical significance of these findings has not been fully investigated. We examined the fundus oculi in a cohort of 122 adult patients with AML at presentation and analyzed some clinical and biological features to assess whether there was any association with RA. For this purpose, we subdivided the patients into two groups according to the presence or absence of RA (groups 1 and 2, respectively). We considered current laboratory parameters such as white blood cell (WBC) count, hemoglobin (Hb), platelets and serum lactate dehydrogenase (LDH). Moreover, we subdivided the patients into two groups according to age <60 (group A) or ≧60 years (group B) to evaluate a possible association between RA and response to treatment and/or overall survival (OS). In our series, a higher median age and a lower Hb value were associated with group 1 (p = 0.001 and p = 0.04, respectively); the median LDH value was 812 U/l (range 224–5,551) and 607 (range 181–5,244) for groups 1 and 2, respectively (p = 0.02). There was no association between RA and karyotypic alterations. In terms of outcome, in group A (<60 years), 80% patients who achieved complete remission (CR) were in group 2 vs. 13% nonresponders (NR) (p < 0.0001). Median OS of group 2 patients was 49.7 months compared with 7.2 months for those in group 1 (p = 0.002). In group B, 58% patients who achieved CR were in group 1 vs. 15% NR (p < 0.006). Median OS of patients in group 2 was 14.6 months compared with 2.9 months in group 1 (p = 0.02). Our data show that RA are significantly associated with some biological features and with shorter OS in AML patients and this parameter seems to be an effective clinical sign of poor prognosis in terms of CR.

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“…A raised haematocrit has been reported as a risk factor in one study [21]. Other factors include blood disorders such as leukaemia [60] and thrombocytopenia [61], as well as the use of thrombolytic, anticoagulant and antiplatelet drugs. This includes ethanol, and a regular intake of three or more units is consistently associated with PICH.…”

Section: Causes and Risk Factorsmentioning

confidence: 99%

Cerebral Haemorrhage

MacWalter

Ersoy²,

Wolfson³

2001

Gerontology

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While there have been substantial improvements in the management of patients with cerebral infarction and there are likely to be further improvements over the next decade, the same may not be true for cerebral haemorrhage. Diagnostic facilities and neurosurgical techniques have improved but not all patients are benefiting from these. The current literature is reviewed. Further controlled trials of the utility of modern neurosurgical techniques are urgently required as at present no therapeutic intervention holds out hope for these patients other than optimum medical management. The main focus must be on prevention.

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Macular Haemorrhage in Adult Acute Leukaemia Patients at Presentation and the Risk of Subsequent Intracranial Haemorrhage

Cited by 25 publications

References 5 publications

Prognostic significance of retinopathy at presentation in adult acute leukemia

Prognostic significance of retinopathy at presentation in adult acute leukemia

Retinal Abnormalities in Newly Diagnosed Adult Acute Myeloid Leukemia

Cerebral Haemorrhage

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