Acute Promyelocytic Leukemia-Associated Thrombosis

Abstract

Patients with acute promyelocytic leukemia (APL) are prone to both bleeding and thrombosis. The bleeding complications are well known. In contrast, APL-associated thrombosis is relatively underappreciated. We aimed to explore the issue of APL-associated thrombosis events. In the past 20 years, 127 cases with APL were found in our hospital database. We collected their coagulation laboratory profiles, including leukemia burdens, white blood cell and platelet counts, prothrombin time, activated partial thromboplastin time, fibrinogen levels, and disseminated intravascular coagulation scores. Data were compared between patients with or without thrombosis. Clinical outcomes and potential risk factors were obtained for analysis. Ten cases with APL-associated thrombosis were found. The incidence of thrombosis was 7.9% in our cohort. Five patients had cerebral infarction, 5 had catheter-related thrombosis and 1 had acute myocardial infarction. No laboratory data were associated with clinical thrombosis. Three patients died during the induction phase but thrombosis was not the direct cause of death for any of them. We conclude that patients with APL are susceptible to thrombosis in addition to bleeding. Laboratory coagulation parameters did not predict thrombosis in our series. Ischemic stroke and catheter-related thrombosis were the most common events in our Taiwanese cohort. Such a thrombosis pattern is unique and worth further investigation.

Acute Promyelocytic Leukemia: a Single Center Study from Southern Pakistan

“…Some series report the thrombotic manifestation of APL with a frequency as high as 2-10% (Chang et al, 2013;Mitrovic et al, 2015). We did not come across any such findings which is rather unusual.…”

Budd-Chiari Syndrome and Acute Liver Failure: An Uncommon Presentation of Acute Myeloid Leukaemia

“…Other haematological neoplasms are rarely associated to BCS [3, 6, 8], and, to our knowledge, there are only 3 reported cases with simultaneous hepatic vein thrombosis and AML as initial presentation [9-11]. All these cases are related to acute promyelocytic leukaemia, which is known to turn patients more susceptible to thrombosis besides bleeding disorders [13]. Our patient did not present with a M3, but rather M1 (acute myeloblastic leukaemia with minimal maturation) form of AML, which has never been associated to BCS before.…”

New perspectives on treatment strategies for patient with acute myeloid leukemia and complex karyotype abnormalities after percutaneous coronary intervention

“…[13] On the other hand, APL patients with bleeding are well known, high incidence of early hemorrhagic deaths remains the greatest contributor to chemotherapy failure. [14] More importantly, bleeding risk elevates after leukemia chemotherapy and postoperative rehabilitation, making how to handle thrombosis in AML more complicated.…”