title: Disseminated intravascular coagulation at diagnosis is a strong predictor for thrombosis in acute myeloid leukemia.
abstract: Venous thromboembolism is a common complication in patients with cancer, but only limited data are available in acute myeloid leukemia (AML). In a prospective study in a cohort of 272 adult patients (aged 18-65) and an independent validation cohort of 132 elderly adults (aged >60) with newly diagnosed AML, we assessed markers of disseminated intravascular coagulation (DIC) (fibrinogen, D-dimer, α-2-antiplasmin, antitrombin, prothrombin time, and platelet count) and the DIC score according the International Society of Thrombosis and Haemostasis and their associations with the occurrence of venous and arterial thrombosis during follow-up. The prevalence of thrombosis was 8.7% (4.7% venous, 4.0% arterial) in the younger adults over a median follow-up of 478 days and 10.4% (4.4% venous, 5.9% arterial) in elderly patients. Most thrombotic events (66%) occurred before the start of the second course of chemotherapy. The calculated DIC score significantly predicted venous and arterial thrombosis with a hazard ratio (HR) for a high DIC score (≥5) of 4.79 (1.71-13.45). These results were confirmed in the validation cohort of elderly patients with AML (HR 11.08 [3.23-38.06]). Among all DIC parameters, D-dimer levels are most predictive for thrombosis with an HR of 12.3 (3.39-42.64) in the first cohort and an HR of 7.82 (1.95-31.38) in validation cohort for a D-dimer >4 mg/L vs ≤4 mg/L. It is concluded that venous and arterial thrombosis may develop in ∼10% of AML patients treated with intensive chemotherapy, which to a large extent can be predicted by the presence of DIC at time of AML diagnosis.
authors.affiliation: Department of Hematology/Oncology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.|Department of Hematology, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands.
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Libourel
authors.affiliation: Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands; and.
authors.forename: Clara P W
authors.initials: CPW
authors.lastname: Klerk
authors.affiliation: Clinical Trial Center-HOVON Data Center, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Yvette
authors.initials: Y
authors.lastname: van Norden
authors.affiliation: Department of Hematology, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands.
authors.forename: Moniek P M
authors.initials: MPM
authors.lastname: de Maat
authors.affiliation: Department of Hematology, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands.
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: Kruip
authors.affiliation: Department of Hematology, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands.
authors.forename: Pieter
authors.initials: P
authors.lastname: Sonneveld
authors.affiliation: Department of Hematology, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands.
authors.forename: Bob
authors.initials: B
authors.lastname: Löwenberg
authors.affiliation: Department of Hematology, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands.
authors.forename: Frank W G
authors.initials: FWG
authors.lastname: Leebeek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D004211:Disseminated Intravascular Coagulation / Q000150:complications* / Q000175:diagnosis; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013927:Thrombosis / Q000175:diagnosis* / Q000209:etiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D