Hypofibrinogenemia in non-M3 acute myeloid leukemia. Incidence, clinical and laboratory characteristics and prognosis.
Among 379 patients with AML with FAB type M1, 2 and M4-7 diagnosed between 1978 and 1997 in our institution, 19 (5%) had hypofibrinogenemia (HF), ie a fibrinogen level <180 mg/dl. Compared to patients with normal fibrinogen (n = 360) patients with HF had significantly elevated markers of activation of coagulation (TAT, F1.2, FPA) and fibrinolysis (D-dimer, FDP) indicating that disseminated intravascular coagulation/hyperfibrinolysis was the cause of hypofibrinogenemia. Patients with HF had significantly longer prothrombin times, thrombin clotting and reptilase times. Factor X and VIII were significantly lower than in patients without HF. With the exception of M7, HF occurred in all FAB subtypes, but was most common in M5 (12.1%). Patients with HF did not differ from those with normal fibrinogen with regard to age, sex, leukocyte count and other hematological parameters. During induction chemotherapy fibrinogen normalized rapidly (median 5 days) and there was no increased incidence of early hemorrhagic death. The overall and disease-free survival was similar to that of patients without HF.
Department of Medicine I, Clinical Institute of Medical and Chemical Laboratory Medicine, University of Vienna, Austria.
A
A
Weltermann
I
I
Pabinger
K
K
Geissler
U
U
Jäger
H
H
Gisslinger
P
P
Knöbl
S
S
Eichinger
P A
PA
Kyrle
P
P
Valent
W
W
Speiser
I
I
Schwarzinger
C
C
Mannhalter
K
K
Lechner
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000150:complications* / Q000453:epidemiology; D018572:Disease-Free Survival; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D006801:Humans; D015994:Incidence; D007621:Karyotyping; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy / Q000235:genetics; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000235:genetics; D015514:Oncogene Proteins, Fusion / Q000235:genetics; D011379:Prognosis; D014212:Tretinoin / Q000627:therapeutic use
D000970:Antineoplastic Agents; D009363:Neoplasm Proteins; D015514:Oncogene Proteins, Fusion; C093476:promyelocytic leukemia-retinoic acid receptor alpha fusion oncoprotein; D014212:Tretinoin; D005340:Fibrinogen