title: Co-occurrence of hyperleukocytosis and elevated fibrin-fibrinogen degradation product levels is a risk factor for early intracranial hemorrhage in patients with de novo acute leukemia.
abstract: Early intracranial hemorrhage (eICH) is a potentially fatal complication of acute leukemia. We analyzed risk factors for eICH in patients with de novo acute leukemia. Ninety-one de novo acute leukemia patients at our institution between September 2003 and June 2014 were included. Of the 91 patients, eight (8.8 %) and 83 were included in the eICH and non-eICH groups, respectively. Univariate analysis demonstrated that white blood cell (WBC) count (P = 0.018), fibrin-fibrinogen degradation product (FDP) level (P = 0.0075), co-occurrence of WBC ≥50,000/µl and FDP level >40 µg/ml (P < 0.001), and fever (P = 0.248) were all significant predictors of eICH at the 0.25 level. In a subsequent multivariate analysis involving these parameters, only the combination of hyperleukocytosis and elevated FDP levels was found to be significant at the 0.05 level. A significant difference in the duration of the overall survival (OS) period was detected between patients that did and did not exhibit the combination of hyperleukocytosis and elevated FDP levels (P < 0.001). Co-occurrence of hyperleukocytosis and elevated FDP levels is a significant risk factor for eICH in patients with de novo acute leukemia and has a significant adverse affect on OS.
authors.affiliation: Sakura Life Clinic, ABY Building 1F, 4-12-10, Ishihara, Sumida-ward, Tokyo, 130-0011, Japan. kichika@juntendo.ac.Jp.
authors.forename: Kunimoto
authors.initials: K
authors.lastname: Ichikawa
authors.affiliation: Division of Hematology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Edahiro
authors.affiliation: Division of Hematology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Gotoh
authors.affiliation: Department of Hematology, Juntendo University Shizuoka Hospital, Shizuoka, Japan.
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Iiduka
authors.affiliation: Division of Hematology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Komatsu
authors.affiliation: Department of Hematology, Juntendo University Shizuoka Hospital, Shizuoka, Japan.
authors.forename: Michiaki
authors.initials: M
authors.lastname: Koike
mesh_terms: D000208:Acute Disease; D000328:Adult; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D020300:Intracranial Hemorrhages / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D007938:Leukemia / Q000150:complications* / Q000401:mortality; D007958:Leukocyte Count; D007964:Leukocytosis; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D005338:Fibrin Fibrinogen Degradation Products
keywords: Acute leukemia; Disseminated intravascular coagulation; Early intracranial hemorrhage; Fibrin–fibrinogen degradation product; Hyperleukocytosis