P1692: Predictive Model for Vein Thromboembolic Events Development in Patients With Acute Myeloid Leukemia

Mitrovic, M.; Virijević, M.; Pantic, N.; Pravdic, Z.; Sabljic, N.; Bukumiric, Z.; Cvetković, Mirjana; Rajić, J.; Balint, Milena Todorovic; Ana, V.; Suvajdzic-Vukovic, Nada; Antic, D.

doi:10.1097/01.hs9.0000849624.24408.8e

Cited by 3 publications

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“…Patients with a prior history of thrombosis in our group had a more than two-fold higher risk of recurrence, which is in line with data from studies in the general population. A higher rate of prior VTE has been associated with an increased recurrence rate in patients with cancer-associated thrombosis, acute leukemias, and particularly AML [ 6 , 9 , 21 , 25 , 26 ]. Male patients in our study had a two-times higher risk for thrombosis development compared with women.…”

Section: Discussionmentioning

confidence: 99%

“…To develop a clinical prediction model, at least 5–10 events for each predictor were needed. Therefore, based on our center’s previous data, where 11.4% of patients with AML developed VTE, a population of 600 patients was considered sufficient for exploring the predictive model [ 21 ]. In statistical analysis, we used all eligible cases without imputation.…”

Section: Methodsmentioning

confidence: 99%

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Venous thromboembolism in patients with acute myeloid leukemia: development of a predictive model

Mitrovic,

Pantic,

Bukumiric

et al. 2024

Thrombosis J

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Background Patients with acute myeloid leukemia (AML) are at increased risk of venous thromboembolic events (VTE). However, thromboprophylaxis is largely underused. Objectives This study aimed to determine possible VTE development risk factors and to develop a novel predictive model. Methods We conducted a retrospective cohort study of adult patients with newly diagnosed AML. We used univariate and multivariable logistic regression to estimate binary outcomes and identify potential predictors. Based on our final model, a dynamic nomogram was constructed with the goal of facilitating VTE probability calculation. Results Out of 626 eligible patients with AML, 72 (11.5%) developed VTE during 6 months of follow-up. Six parameters were independent predictors: male sex (odds ratio [OR] 1.82, 95% confidence interval [CI]: 1.077–2.065), prior history of thrombotic events (OR 2.27, 95% CI: 1.4–4.96), international normalized ratio (OR 0.21, 95% CI: 0.05–0.95), Eastern Cooperative Oncology Group performance status (OR 0.71, 95% CI: 0.53–0.94), and intensive therapy (OR 2.05, 95% CI: 1.07–3.91). The C statistics for the model was 0.68. The model was adequately calibrated and internally validated. The decision-curve analysis suggested the use of thromboprophylaxis in patients with VTE risks between 8 and 20%. Conclusion We developed a novel and convenient tool that may assist clinicians in identifying patients whose VTE risk is high enough to warrant thromboprophylaxis.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Venous thromboembolism in patients with acute myeloid leukemia: development of a predictive model

Mitrovic,

Pantic,

Bukumiric

et al. 2024

Thrombosis J

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“…18 Also, studies showed that central venous line-related thromboses are the most frequent type of thromboses in AML, with incidence of 10%, while the incidences of DVT and pulmonary embolisms accounts for 2.63 and 0.01%, respectively. [19][20][21][22] On the contrary, central venous line-related thromboses in APL are less frequent than all other types of thromboses. Only few studies in APL reported central venous line-related thrombosis all occurring during induction of chemotherapy.…”

Section: Incidence Of Thrombosis In Apl Underrecognitionmentioning

confidence: 99%

“…[8][9][10][11][12][13][14]16,17 According to the reported data, thromboses most frequently occur at presentation or during the induction of chemotherapy and are rare during the consolidation phase. [10][11][12][13][14][15][16]18,19 The heterogeneity in the reported incidence could be due to the retrospective nature of the studies, variable and usually small sample sizes, a mix of patient population. While majority of trials were focused only on presentation and therapy induction period, some studies also analyzed thrombotic incidence during post-induction and consolidation.…”

Section: Incidence Of Thrombosis In Apl Underrecognitionmentioning

confidence: 99%

Thrombosis in Acute Promyelocytic Leukemia: The Current Understanding

Sabljic,

Mitrovic,

Pantic

et al. 2024

Hamostaseologie

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Despite enormous improvement in the management of patients with acute promyelocytic leukemia (APL), the distinctive coagulopathy observed at presentation in affected patients is often life-threatening. While hemorrhagic manifestations are well known and described in this setting, APL-related thromboses are underappreciated. Data regarding this complication are scarce showing variable incidence. Furthermore, risk factors for thrombosis are inconsistent and unreliable; so, differentiation of increased risk of hemorrhage from an increased thrombotic risk is quite difficult in the absence of adequate predictive scores. Besides, prophylactic use of anticoagulants and recombinant thrombomodulin are a matter of ongoing debate. Also, due to the common feature of thrombocytopenia and other hemorrhagic risks, patients with APL are excluded from trials analyzing anticoagulant prophylaxis in cancers; so, data from prospective trials are lacking. A detailed analysis of thrombotic risks in APL with the development of a reliable risk stratification model is needed to further improve the care of APL patients.

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Risk Factors for Venous Thromboembolism in Acute Promyelocytic Leukemia

Sabljic,

Pantic,

Virijevic

et al. 2024

Cancers

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Background: Acute promyelocytic leukemia (APL) is frequently associated with disseminated intravascular coagulation (DIC), leading to potentially life-threatening bleeding. Compared to bleeding, thromboses are a less commonly encountered problem. Objective: The objective of our study was to identify the incidence and predictive value of demographic data, clinical–laboratory parameters, and thrombosis risk assessment models (RAMs) for venous thromboembolism (VTE) in patients with APL. Methods: This study was a retrospective study conducted on adult patients with APL who were treated between 2006 and 2024 at the Clinic of Hematology UCCS with all-trans retinoic acid (ATRA) and anthracycline. The demographic and clinical–laboratory data related to VTE were collected and analyzed alongside the predictive value of two RAMs proposed by Al-Ani and Paterno and colleagues. Results: Among the one-hundred-fifty-five adult patients with APL, VTE was diagnosed in twenty-eight cases (18.1%). The most common location for thrombosis was in the central venous catheter (CVC), which affected twelve (42.8%) patients. A total of six (21.4%) patients had deep vein thrombosis (DVT), one patient (3.6%) showed a pulmonary embolism (PE), and thrombosis at unusual sites was present in nine (32.1%) patients. Our analyses showed that neither Al-Ani’s RAM nor the RAM proposed by Paterno and colleagues were predictive for VTE in patients with APL. The C statistics value for the Al-Ani model was ROC = 0.514, and, for Paterno’s RAM, it was ROC = 0.521. The independent risk factors for VTE, identified via multivariate analysis, were CD114 expression (p = 0.005, OR = 6.4 IC 95%: [1.8–23.2]) and the absence of bleeding at presentation (p = 0.013, OR = 0.086 IC 95%: [0.01–0.59]). Conclusions: To the best of our knowledge, this is the first study showing that a higher expression of CD114 increases the risk of VTE. The absence of bleeding at presentation in patients with APL correlates with thrombosis. Further analyses are needed to confirm these findings and help to develop therapeutic strategies to prevent VTE complications. So far, no risk assessment model has been sufficient to stratify patients with APL according to their risk of VTE.

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P1692: Predictive Model for Vein Thromboembolic Events Development in Patients With Acute Myeloid Leukemia

Cited by 3 publications

References 0 publications

Venous thromboembolism in patients with acute myeloid leukemia: development of a predictive model

Venous thromboembolism in patients with acute myeloid leukemia: development of a predictive model

Thrombosis in Acute Promyelocytic Leukemia: The Current Understanding

Risk Factors for Venous Thromboembolism in Acute Promyelocytic Leukemia

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