BACKGROUND: Thromboembolism can occur during acute leukemia, especially acute lymphoid leukemia (ALL) treated with L-asparaginase. Yet, most reports are anecdotical and scarce data are available on the risk of thrombosis in acute myeloid leukemia (AML). OBJECTIVES: To evaluate the risk of thrombosis in patients with acute leukemia. PATIENTS AND METHODS: Three-hundred and seventy-nine consecutive adult patients with newly diagnosed acute leukemia were recruited in an observational cohort study conducted from January 1994 to December 2003. Diagnosis was ALL in 69 patients, acute promyelocytic leukemia (APL; FAB subtype M3) in 31, and non-M3 AML in 279. All first or recurrent symptomatic thromboembolic events objectively diagnosed were recorded. RESULTS: Twenty-four patients of the overall 379 (6.3%; 95% CI 4.1%-9.2%) had a first thrombosis, venous in 80% of the cases and arterial in 20%. At diagnosis, thrombosis was a presenting manifestation in 13 cases (3.4% of the whole cohort): 1.4% in ALL, 9.6% in APL, and 3.2% in non-M3 AML patients. Follow-up was carried out on 343 patients without thrombosis at diagnosis and further 11 thrombotic events (3.2%) were recorded. At 6 months from diagnosis, the cumulative incidence of thrombosis was 10.6% in ALL, 8.4% in APL, and 1.7% in non-M3 AML patients. The patients who received L-asparaginase had a 4.9-fold increased risk of thrombosis in comparison with those who did not (95% CI 1.5-16.0). The fatality rate due to thrombosis was 0.8%. CONCLUSIONS: In patients with acute leukemia, the risk of thrombosis is not negligible. Thombosis can be a presenting symptom at diagnosis in a significant portion of cases with APL (9.6%) and non-M3 AML (3.2%); a similar rate of thrombosis can occur during the subsequent course of the disease. The incidence of symptomatic thrombosis at diagnosis is relatively low in ALL patients (1.4%), but is significantly increased by further treatment up to 10.6%. Strategies of antithrombotic prophylaxis should be investigated in this setting.
BACKGROUND:Thromboembolism can occur during acute leukemia, especially acute lymphoid leukemia (ALL) treated with L-asparaginase. Yet, most reports are anecdotical and scarce data are available on the risk of thrombosis in acute myeloid leukemia (AML). OBJECTIVES: To evaluate the risk of thrombosis in patients with acute leukemia. PATIENTS AND METHODS: Three-hundred and seventy-nine consecutive adult patients with newly diagnosed acute leukemia were recruited in an observational cohort study conducted from January 1994 to December 2003. Diagnosis was ALL in 69 patients, acute promyelocytic leukemia (APL; FAB subtype M3) in 31, and non-M3 AML in 279. All first or recurrent symptomatic thromboembolic events objectively diagnosed were recorded. RESULTS: Twenty-four patients of the overall 379 (6.3%; 95% CI 4.1%-9.2%) had a first thrombosis, venous in 80% of the cases and arterial in 20%. At diagnosis, thrombosis was a presenting manifestation in 13 cases (3.4% of the whole cohort): 1.4% in ALL, 9.6% in APL, and 3.2% in non-M3 AMLpatients. Follow-up was carried out on 343 patients without thrombosis at diagnosis and further 11 thrombotic events (3.2%) were recorded. At 6 months from diagnosis, the cumulative incidence of thrombosis was 10.6% in ALL, 8.4% in APL, and 1.7% in non-M3 AMLpatients. The patients who received L-asparaginase had a 4.9-fold increased risk of thrombosis in comparison with those who did not (95% CI 1.5-16.0). The fatality rate due to thrombosis was 0.8%. CONCLUSIONS: In patients with acute leukemia, the risk of thrombosis is not negligible. Thombosis can be a presenting symptom at diagnosis in a significant portion of cases with APL (9.6%) and non-M3 AML (3.2%); a similar rate of thrombosis can occur during the subsequent course of the disease. The incidence of symptomatic thrombosis at diagnosis is relatively low in ALL patients (1.4%), but is significantly increased by further treatment up to 10.6%. Strategies of antithrombotic prophylaxis should be investigated in this setting.
Authors: David Hernández-Espinosa; Antonia Miñano; Constantino Martínez; Elena Pérez-Ceballos; Inmaculada Heras; José L Fuster; Vicente Vicente; Javier Corral Journal: Am J Pathol Date: 2006-07 Impact factor: 4.307
Authors: Madhvi Rajpurkar; Todd A Alonzo; Yi-Cheng Wang; Robert B Gerbing; Alan S Gamis; James H Feusner; John Gregory; Matthew A Kutny Journal: J Pediatr Hematol Oncol Date: 2019-01 Impact factor: 1.289
Authors: H Sibai; J T Seki; T Q Wang; N Sakurai; E G Atenafu; K W L Yee; A C Schuh; V Gupta; M D Minden; A D Schimmer; J M Brandwein Journal: Curr Oncol Date: 2016-08-12 Impact factor: 3.677
Authors: Mariasanta Napolitano; Giorgia Saccullo; Marco Marietta; Monica Carpenedo; Giancarlo Castaman; Elisabetta Cerchiara; Antonio Chistolini; Laura Contino; Valerio De Stefano; Anna Falanga; Augusto B Federici; Elena Rossi; Rita Santoro; Sergio Siragusa; Valerio De Stefano; Anna Falanga; Alberto Tosetto; Giuseppe Avvisati; Monica Carpenedo; Augusto B Federici; Marco Marietta; Mariasanta Napolitano; Elena Rossi; Cristina Santoro; Giancarlo Castaman; Elisabetta Cerchiara; Antonio Chistolini; Laura Contino; Maria Gabriella Mazzucconi; Ilaria Nichele; Laura Russo; Roberto Santi; Rita Carlotta Santoro; Sergio Siragusa; Giuseppe Tagariello Journal: Blood Transfus Date: 2018-10-24 Impact factor: 3.443
Authors: Eun-Ju Lee; B Douglas Smith; Jessica W Merrey; Alfred I Lee; Nikolai A Podoltsev; Lisa Barbarotta; Mark R Litzow; Thomas Prebet; Selina M Luger; Steven Gore; Michael B Streiff; Amer M Zeidan Journal: Clin Lymphoma Myeloma Leuk Date: 2015-08-06