Intracranial Hemorrhage in Patients Newly Diagnosed with Acute Myeloid Leukemia and Hyperleukocytosis

Lieberman, Frank S.; Villgran, Vipin; Normolle, Daniel P.; Boyiadzis, Michael

doi:10.1159/000478690

Cited by 9 publications

(3 citation statements)

References 7 publications

(9 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Six patients developed intracranial bleeding (ICH). One of the patients with ICH had severe leukocytosis (WBC > 100 × 10 9 per litre) with predominance of myeloblasts, known to be associated with increased risk of intracranial haemorrhage [ 24 ].…”

Section: Resultsmentioning

confidence: 99%

Risks of bleeding and thrombosis in intensive care unit patients with haematological malignancies

Russell

Holst

Kjeldsen

et al. 2017

Ann. Intensive Care

View full text Add to dashboard Cite

BackgroundPatients with malignant haematological disease and especially those who require intensive care have an increased risk of bleeding and thrombosis, but none of these data were obtained in ICU patients only. We assessed the incidence of bleeding and thrombotic complications, use of blood products and risk factors for bleeding in an adult population of ICU patients with haematological malignancies.MethodsWe screened all patients with acute leukaemia and myelodysplastic syndrome admitted to a university hospital ICU during 2008–2012. Bleeding in ICU was scored according to the WHO grading system, and risk factors were evaluated using unadjusted and adjusted analyses.ResultsIn total, 116 of 129 ICU patients were included; their median length of stay was 7 (IQR 2–16) days. Of these, 66 patients (57%) had at least one bleeding episode in ICU; they bled for 3 (2–6) days and most often from lower and upper airways and upper GI tract. Thirty-nine (59%) of the 66 patients had severe or debilitating (WHO grade 3 or 4) bleeding. The median platelet count on the day of grade 3 or 4 bleeding was 23 × 109 per litre (IQR 13–39). Nine patients (8%) died in ICU following a bleeding episode; five of these had intra-cerebral haemorrhage. Platelet count on admission was associated with subsequent bleeding (adjusted odds ratio 1.18 (95% CI 1.03–1.35) for every 10 × 109 per litre drop in platelet count, p = 0.016). Eleven of the 116 patients (9%) developed a clinically significant thrombosis in ICU, which was the cause of death in four patients. The median platelet count was 20 × 109 per litre (15–48) at the time of thrombosis. The patients received a median of 6 units of red blood cells, 1 unit of fresh frozen plasma and 8 units of platelet concentrates in ICU.ConclusionsSevere and debilitating bleeding complications were frequent in our ICU patients with haematological malignancies, but thrombosis also occurred in spite of low platelet counts. Platelet count on ICU admission was associated with subsequent bleeding.Electronic supplementary materialThe online version of this article (10.1186/s13613-017-0341-y) contains supplementary material, which is available to authorized users.

show abstract

Section: Resultsmentioning

confidence: 99%

Risks of bleeding and thrombosis in intensive care unit patients with haematological malignancies

Russell

Holst

Kjeldsen

et al. 2017

Ann. Intensive Care

View full text Add to dashboard Cite

show abstract

“…8 Complications from hyperleukocytosis such as hyperviscosity, and tumor lysis syndrome, may lead to bleeding, respiratory distress, and thromboembolism, thus increasing the risk of mortality. 6,9,10 We found that 84% of the high-risk status patients died, which was significantly higher than mortality in the standard-risk patients (57%). The mean survival times were 583.40 (70.75) days and 1,407.96 (139.81) days, respectively.…”

Section: Discussionmentioning

confidence: 72%

3-year survival rate in acute lymphoblastic leukemia: comparison of ALL-2006 and ALL-2013 Protocols

Meirizkia¹,

Ayu²,

Indra³

et al. 2021

View full text Add to dashboard Cite

Background With advances in supportive and risk-stratified therapy, the 5-year survival rate of acute lymphoblastic leukemia has reached 85.5%. The ALL-2006 treatment protocol was modified and renamed the ALL-2013 protocol, with dose and duration changes. Objective To compare outcomes of the ALL-2006 and ALL-2013 protocols, with regards to mortality, remission, relapse, and three-year survival rates. Methods This was retrospective cohort study. Subjects were acute lymphoblastic leukemia (ALL) patients treated from 2011 to 2018 in Mohamad Hoesin Hospital, Palembang, South Sumatera. The three-year survival rates, relapse, remission rates and comparison of ALL-2006 and ALL-2013 protocols were analyzed with Kaplan-Meier method. Results Mortality was significantly correlated with age at diagnosis <1 year and >10 years, hyperleukocytosis, and high-risk disease status. Patients aged 1 to 10 years, with leukocyte count <50,000/mm3 and standard-risk status had significantly higher likelihood of achieving remission. Mortality was not significantly different between the ALL-2006 protocol group [70.6%; mean survival 1,182.15 (SD 176.89) days] and the ALL-2013 protocol group [72.1%; mean survival 764.23 (SD 63.49) days]; (P=0.209). Remission was achieved in 39.2% of the ALL-2006 group and 33% of the ALL-2013 group (P>0.05). Relapse was also not significantly different between the two groups (ALL-2006: 29.4% vs. ALL-2013: 17.9%; P>0.05). Probability of death in the ALL-2006 group was 0.3 times lower than in the ALL-2013 group (P<0.05), while that of the high-risk group was 3 times higher. Remission was 2.19 times higher in those with leukocyte <50,000/mm3 compared to those with hyperleukocytosis. In addition, relapse was significantly more likely in high-risk patients (HR 2.96; 95%CI 1.22 to 7.19). Overall, the 3-year survival rate was 33%, with 41.7% in the ALL-2006 group and 30.7% in the ALL-2013 group. Conclusion Three-year survival rate of ALL-2006 protocol is higher than that of ALL-2013 protocol but is not statistically significant. Age at diagnosis <1 year and >10 years, hyperleukocytosis, and high-risk group are significantly correlated with higher mortality and lower remission rates. However, these three factors are not significantly different in terms of relapse.

show abstract

“…Абсолютные риски смерти вследствие кровотечения и лейкостаза варьируют от 1,8 % в общей популяции детей с ОМЛ до 14,3 % в популяции с гиперлейкоцитозом более 200 × 10 9 /л [22]. Наиболее распространенным видом кровотечений у детей с ОМЛ, приводящим к летальному исходу, являются внутричерепные кровотечения, частота возникновения которых составляет 5 % [23].…”

Section: острый миелобластный лейкозunclassified

Modern aspects of the pathogenesis, diagnosis and therapy of hemostasis disorders in children with acute leukemias

Koltsova¹,

Баландина²,

Seregina³

et al. 2019

Ross. ž. det. gematol. onkol.

View full text Add to dashboard Cite

Patients with oncohematological diseases, both children and adults, face high risks of thrombotic and hemorrhagic complications.About 40 % of pediatric patients with acute lymphoblastic leukemia develop bleedings, and the incidence of thrombosis in this disease ranges from 1 to 36 %. Most thromboses are associated with the use of central venous catheters and the use of L-asparaginase, which leads to a significant reduction in the synthesis of coagulation proteins.Massive hemorrhages account for two-thirds of all causes of early death in pediatric patients with acute myelogenous leukemia (AML). Absolute risks of death due to bleeding and leukostasis range from 1.8 % in the total population of children with AML to 14.3 % in a population with hyperleukocytosis more than 200 × 109 /l. The risk of thrombotic complications in children with AML varies between 3.4–11 %. In patients with AML, complex systemic coagulopathies may occur, such as disseminated intravascular coagulation (DIC), excessive fibrinolysis, or nonspecific proteolysis. This scale is not yet applicable due to the lack of research on its effectiveness in the pediatric population. The laboratory diagnostics of hemostasis is difficult due to the combined nature of thrombotic and hemorrhagic complications: bleeding, thrombosis and even DIC syndrome (combining both hyper- and hypocoagulation phases) can be expected in each specific patient with hemoblastosis. Because of the long-term nature of the treatment and the varying intensity of the various treatment units, the patient’s hemostasis during disease manifestation does not allow one to predict with any certainty the complications on induction or consolidation therapy. Involving all the components of the hemostasis system – vascular, platelet and plasma – into the pathological process makes prediction and diagnosis of thrombohemorrhagic complications impossible with the help of standard hemostatic tests and a general blood test, since these tests are designed to assess the concentrations of individual proteins and the functioning of individual components of the hemostatic system, and does not assess the balance between its procoagulant and anticoagulant components. Global hemostatic tests such as thromboelastography, thrombodynamics and thrombin generation test adequately reflect hypercoagulable conditions and can serve as a basis for the development of a new set of laboratory hemostasis tests.Conflict of interest. F.I. Ataullakhanov is co-founder of HemaCore LLC, which holds several patents and patent applications that are related to the diagnostic use of Thrombodynamics® (Ataullakhanov F.I., international patent applications: PCT/CH2007/000543 filing date 02.11.2007 and РСТ/RU2012/000570 filing date 16.07.2012). None of the other authors has any competing interests to declare.

show abstract

Intracranial Hemorrhage in Patients Newly Diagnosed with Acute Myeloid Leukemia and Hyperleukocytosis

Cited by 9 publications

References 7 publications

Risks of bleeding and thrombosis in intensive care unit patients with haematological malignancies

Risks of bleeding and thrombosis in intensive care unit patients with haematological malignancies

3-year survival rate in acute lymphoblastic leukemia: comparison of ALL-2006 and ALL-2013 Protocols

Modern aspects of the pathogenesis, diagnosis and therapy of hemostasis disorders in children with acute leukemias

Contact Info

Product

Resources

About