[Therapy of disseminated intravascular coagulation in acute promyelocytic leukemias. Apropos of 19 cases].
OBJECTIVE
To evaluate our experience in the treatment of disseminated intravascular coagulation (DIC) associated to AML-M3 with substitution therapy with or without heparin.


METHODS
The clinical records of 19 patients diagnosed of AML-M3 in the Hospital Juan Canalejo, in La Coruña, between 1986 and 1991 were revised. DIC was defined by abnormalities in one or more of the following: prothrombin time, activated partial thromboplastic time, thrombin time, fibrinogenaemia, fibrin/fibrinogen degradation products, D-dimers. The treatment given to 13 patients was only substitutive including platelets, fresh-frozen plasma, cryoprecipitates and antithrombin III. Low-dose sodium heparin (Kabi) in continuous intravenous infusion was associated to the treatment of the remaining 6 patients. With regard to the leukaemic therapy, most of the patients received daunorubicin, 2 mg/kg/day x 5 days, and AraC, 100 mg/Kg/day x 7 days.


RESULTS
All patients showed haemorrhagic symptoms at diagnosis, and laboratory data of DIC were present in 11 cases (57%). The mean duration of DIC was 6.5 days for the patients receiving substitutive treatment and 9.5 days for those given heparin. Complete remission (CR) of the leukaemia was attained in 12 cases (63%); of the patients treated with heparin, 50% achieved CR whereas 75% of those receiving substitute therapy attained CR. The 24-months survival rate was 30% for the patients treated with substitutive therapy and 16% for those treated with heparin. The incidence of death associated to haemorrhage during induction therapy was 30% for the substitutive treatment group and 50% for the heparin group.


CONCLUSIONS
Shorter duration of DIC, lesser rate of early death, higher CR rate and longer 2-year survival were found in those AML-M3 patients not receiving heparin.
Rodríguez Gómez
M
M
Servicio de Hematologiía-Hemoterapia, Hospital Juan Canalejo Teresa Herrera, La Coruña.
López Fernández
M F
MF
Batlle
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000990:Antithrombin III / Q000627:therapeutic use; D001780:Blood Coagulation Tests; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006470:Hemorrhage / Q000209:etiology; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D010949:Plasma; D017713:Platelet Transfusion; D012074:Remission Induction; D016896:Treatment Outcome
D003561:Cytarabine; D000990:Antithrombin III; D006493:Heparin; D008942:Mitoxantrone; D003630:Daunorubicin
Terapéutica de la coagulación intravascular diseminada en las leucemias agudas promielocíticas. A propósito de 19 casos.