Disseminated intravascular coagulation in non-Hodgkin lymphoma

Chi, SungGi; Ikezoe, Takayuki

doi:10.1007/s12185-015-1854-5

Cited by 12 publications

(10 citation statements)

References 10 publications

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“…As for the liver dysfunction in hematological disease with DIC, Chi S et al reported that Liver dysfunction in ML such as bilirubin, aminotransferases, serum choline esterase, and albumin levels, were worse in patients with DIC than those without DIC, indicating impaired production of coagulation factors [33]. Furthermore, DIC exerts significantly negative impact on prognosis of non-Hodgkin lymphoma [33]. Similarly, in our present study, the liver dysfunction had significant impact for the degree of accordance between DIC resolution and treatment outcome in ML.…”

Section: Importance Of Dic Resolution For Os Regardless Of Any Backgrmentioning

confidence: 99%

Analysis of the association between resolution of disseminated intravascular coagulation (DIC) and treatment outcomes in post-marketing surveillance of thrombomodulin alpha for DIC with infectious disease and with hematological malignancy by organ failure

et al. 2020

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Background: Although disseminated intravascular coagulation (DIC) is life-threatening, any organ failure associated with DIC resolution and outcomes have been unclear.Patients and methods: A total of 2795 DIC patients (infection: 1990 were analyzed in the post-marketing surveillance of thrombomodulin alpha (TM-α). The background factors of sequential organ failure assessment (SOFA) and antithrombin (AT) were investigated in DIC with infectious disease for their association with DIC resolution and outcome using κ statistics, indicating DIC resolution and survival or DIC nonresolution and non-survival. The same analyses were performed for total bilirubin, creatinine, lactate dehydrogenase, and underlying disease in DIC with hematological malignancy.Results: In DIC with infectious disease, higher SOFA score severity was closely correlated with lower overall survival in both the DIC resolution and non-resolution groups, but AT activity was not. κ coefficients were 0.234, 0.295, and 0.311 for the SOFA score 0-6, 7-12, and 13-24 groups, respectively. In DIC with hematological malignancy, κ coefficients of total bilirubin were 0.251 and 0.434, and those of creatinine were 0.283 and 0.437 in the normal and abnormal groups, respectively, showing better concordance in the abnormal group than in the normal. Other factors had poor concordance.

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Section: Importance Of Dic Resolution For Os Regardless Of Any Backgrmentioning

confidence: 99%

Analysis of the association between resolution of disseminated intravascular coagulation (DIC) and treatment outcomes in post-marketing surveillance of thrombomodulin alpha for DIC with infectious disease and with hematological malignancy by organ failure

et al. 2020

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“…DIC worsens the clinical outcome of lymphomas and is associated with an elevated, though not prohibitive, surgical risk [21] ; on the other hand, the cornerstone of cancer-associated DIC is the treatment of the underlying disorder. In the present case, the benefits of performing a splenectomy clearly outweighed the risks.…”

Section: Discussionmentioning

confidence: 99%

A 28-Year-Old Woman with Ascites and Multiple Focal Spleen Lesions

Pirovano

Matino

Zecca

et al. 2019

European Journal of Case Reports in Internal Medicine

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Serous effusions complicating the course of lymphomas occur commonly in the pleural space but seldom in the peritoneum, where they most often present as chylous ascites with diagnostic cytology. Almost invariably, in these rare cases, the serum to ascites albumin gradient is low. We describe a 28-year-old woman with anasarca, ascites and a serum to ascites albumin gradient of 1.1 g/dl, consistent with portal hypertension. No tumour cells were detected in the ascitic fluid. However, a CT scan of the chest and abdomen disclosed liver and spleen enlargement and multiple enlarged retroperitoneal lymph nodes, suspicious for a lymphoproliferative disorder. Bone marrow aspiration and biopsy were not diagnostic, so a decision was made to proceed with a splenectomy despite the onset of low-grade disseminated intravascular coagulation. Surgery was uneventful. Diffuse large B cell lymphoma was diagnosed. A liver biopsy taken at the time of surgery demonstrated that the liver parenchyma was massively infiltrated by reactive T lymphocytes surrounding rare large CD20+ tumour cells. This infiltrate had likely led to increased portal pressure attended by ascites formation, which resolved completely after chemotherapy. The case emphasizes the rewards of pursuing a diagnosis supported by a high prior probability even in the presence of apparently discordant laboratory findings, as well as the importance of performing a diagnostic splenectomy in case of splenomegaly with unexplained focal lesions. LEARNING POINTS Lymphomas may present with serous effusion, which is usually chylous and with positive cytology when represented by ascites accumulation; non-chylous effusions can be due to altered lymphatic drainage, extrinsic compression of the portal vein by enlarged lymph nodes as well as massive infiltration of the liver by lymphoma. If the cause of splenomegaly is unclear, diagnostic splenectomy remains a viable option. The diagnosis of lymphoma should always be pursued, even if it requires apparently unwise surgery, since this type of cancer can be treated effectively only if thoroughly characterized pathologically and molecularly.

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“…Heparinoids, including low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH), synthetic serine protease inhibitors, antithrombin products, and recombinant human soluble thrombomodulin (rTM), are approved for the treatment of DIC in Japan. The levels of AT remain within the normal range in most cases of DIC caused by haematological malignancies except for malignant lymphoma (ML) [5,44]. In one study, all malignant lymphoma patients with DIC (n = 18) were at an advanced clinical stage with bone marrow involvement [5].…”

Section: Treatment Of Dic Caused By Haematological Malignancymentioning

confidence: 99%

“…(1) Procoagulant activity Hypercoagulability is present in patients with haematological malignancy-associated DIC, as an increase in plasma levels of coagulation markers such as the thrombin-antithrombin complex (TAT) and soluble fibrin monomer (SF) are noted in these patients [5,[8][9][10][11]. Leukaemia cells aberrantly express tissue factor (TF), which interacts with factor VII and orchestrates the extrinsic coagulation cascade, leading to the production of thrombin, which converts fibrinogen to fibrin, causing fibrin deposition [3].…”

Section: The Pathogenesis Of Dic Caused By Haematological Malignanciesmentioning

confidence: 99%

“…The disease that is most frequently accompanied by DIC is acute promyelocytic leukaemia (APL); nearly 70% of newly diagnosed APL patients develop DIC [3]. Approximately 17% and 11% of non-APL acute myeloid leukaemia (AML) and non-Hodgkin lymphoma patients, respectively, develop DIC at the time of diagnosis [4,5]. The prognosis of patients with haematological malignancies is exacerbated by concomitant DIC.…”

Section: Introductionmentioning

confidence: 99%

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Advances in the diagnosis and treatment of disseminated intravascular coagulation in haematological malignancies

Ikezoe

2020

Int J Hematol

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Haematological malignancies, including acute leukaemia and non-Hodgkin lymphoma, are one of the underlying diseases that frequently cause disseminated intravascular coagulation (DIC), an acquired thrombotic disorder. Concomitant DIC is associated with the severity of the underlying disease and poor prognosis. The Japanese Society on Thrombosis and Hemostasis released the new DIC diagnostic criteria in 2017. This criteria include coagulation markers such as soluble fibrin and the thrombin-antithrombin complex to more accurately evaluate the hypercoagulable state in patients. Among several groups of anticoagulants available, recombinant human soluble thrombomodulin is most frequently used to treat DIC caused by haematological malignancies in Japan. DIC is remitted in parallel with the improvement of the underlying haematological diseases; thus, there is room for debate regarding whether the treatment of DIC would improve the prognosis of patients. Haematopoietic stem cell transplantation as well as the recently introduced chimeric antigen receptor (CAR)-T-cell therapy are innovative therapies to produce a cure in a subset of patients with haematological malignancies. However, coagulopathy frequently occurs after these therapies, which limits the success of the treatment. For example, DIC is noted in approximately 50% of patients after CAT-T-cell therapy in conjunction with cytokine release syndrome. Hematopoietic stem cell transplantation (HSCT) causes endotheliitis, which triggers coagulopathy and the development of potentially lethal complications, such as sinusoidal obstruction syndrome/veno-occlusive disease and transplant-associated thrombotic microangiopathy. This review article describes the pathogenesis, clinical manifestation, diagnosis, and treatment of DIC caused by haematological malignancies, CAR-T-cell therapy, and HSCT.

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Disseminated intravascular coagulation in non-Hodgkin lymphoma

Cited by 12 publications

References 10 publications

Analysis of the association between resolution of disseminated intravascular coagulation (DIC) and treatment outcomes in post-marketing surveillance of thrombomodulin alpha for DIC with infectious disease and with hematological malignancy by organ failure

Analysis of the association between resolution of disseminated intravascular coagulation (DIC) and treatment outcomes in post-marketing surveillance of thrombomodulin alpha for DIC with infectious disease and with hematological malignancy by organ failure

A 28-Year-Old Woman with Ascites and Multiple Focal Spleen Lesions

Advances in the diagnosis and treatment of disseminated intravascular coagulation in haematological malignancies

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