Predictors of Early Thrombotic Events in Adult Patients with Acute Myeloid Leukemia: A Real-World Experience

Abstract

Information regarding the incidence and the prognostic impact of thrombotic events (TE) in non-promyelocytic acute myeloid leukemia (AML) is sparse. Although several risk factors associated with an increased risk of TE development have been recognized, we still lack universally approved guidelines for identification and management of these complications. We retrospectively analyzed 300 consecutive patients with newly diagnosed AML. Reporting the incidence of venous TE (VTE) and arterial TE (ATE) was the primary endpoint. Secondarily, we evaluated baseline patient- and disease-related characteristics with a possible influence of VTE-occurrence probability. Finally, we evaluated the impact of TE on survival. Overall, the VTE incidence was 12.3% and ATE incidence was 2.3%. We identified three independent predictors associated with early-VTE: comorbidities (p = 0.006), platelets count >50 × 109/L (p = 0.006), and a previous history of VTE (p = 0.003). Assigning 1 point to each variable, we observed an overall cumulative incidence of VTE of 18.4% in the high-risk group (≥2 points) versus 6.4% in the low-risk group (0–1 point), log-rank = 0.002. Overall, ATE, but not VTE, was associated with poor prognosis (p < 0.001). In conclusion, TE incidence in AML patients is not negligible. We proposed an early-VTE risk score that could be useful for a proper management of VTE prophylaxis.

Arterial Thrombosis in Patients with Acute Myeloid Leukemia: Incidence and Risk Factors

“…The frequency of ATE in our study (2.9%) is in line with previously published data for AML (2.3%) and cancer patients (2-7%) [6][7][8][9][10][11][12][13][14]. Cancer-related studies have noted an increased risk of ATE in the period preceding cancer diagnosis as well as during the first months following diagnosis, and a quick decline thereafter [6][7][8][9][10][11][12].…”

“…Conventional cardiovascular risk factors, such as male sex, age, diabetes mellitus, hypertension, dyslipidemia, smoking, as well as a previous history of thrombosis and use of antiplatelet or anticoagulant therapy (possibly as a surrogate of pre-existing cardiovascular disease/risk), were associated with ATE in a general population and cancer patients [6][7][8][9][10][11][12]. The history of ATE had the highest association (aHR 2.96; 95% CI 2.77-3.17) [11,13]. Among our patient-related risk factors, BMI > 30, prior history of TE, presence of comorbidities and cardiovascular comorbidities as well as adverse genetic risk group were predictive for ATE in univariate analysis.…”

“…With the exception of patient-related cardiovascular risk factors, previous studies identified a few cancer-related risk factors for ATE, including: cancer type, regional and distant disease (vs. localized), chemotherapy, radiotherapy or surgery (vs. no therapy) [6][7][8][9][10][11][12][13]. An elevated absolute neutrophil count and higher soluble P-selectin levels were identified as potential laboratory risk factors [22].…”

“…Therefore, the prevalence of ATE among those patients was expected to be lower than in those with solid tumors. However, it looks like the prevalence of ATE in AML is as high as in other cancers [13,14]. Data about risk factors for ATE development in AML patients are very rare.…”

Thrombosis in Acute Promyelocytic Leukemia: The Current Understanding

“…[27][28][29] Conversely, authors showed that arterial thromboses led to increased risk of early mortality and were associated with poorer overall survival. 30,31 Results of thromboembolic impact on mortality in the setting of APL are scarce. Reports by Mitrovic et al showed that both arterial and venous thromboses did not affect ED rate or 4-year overall survival.…”