Prevalence and Clinical Characteristics of Acute Myeloid Leukemia Associated with Disseminated Intravascular Coagulation

Abstract

Disseminated intravascular coagulation (DIC) is one of the important complications to develop in patients with acute myeloid leukemia (AML). While acute promyelocytic leukemia (APL) is a strong risk factor for DIC, other clinical features have not been fully defined. We retrospectively analyzed 161 consecutive adult patients with de novo non-APL AML. DIC was diagnosed in 52 patients (32%); 28 patients at diagnosis and 24 soon after the initiation of induction chemotherapy. Leukocyte counts, C-reactive protein, and lactate dehydrogenase were significantly higher in the DIC+ group. Negative expressions of CD13, CD19, CD34, and HLA-DR were more prevalent in the DIC+ group. On multivariate logistic-regression analysis, variables that were independently associated with the development of DIC were high C-reactive protein, high leukocyte count, negative expressions of CD13 and HLA-DR, and cytogenetics with a normal karyotype or 11q23 abnormality. Although DIC is considered to be associated with serious morbidity and occasional mortality, we did not find any significant differences in the complete remission rate, overall or disease-free survival between DIC+ and DIC- groups. This study is the first to define the clinical characteristics associated with DIC in patients with non-APL AML, but exactly how and when DIC should be treated remains to be determined.

Prognostic factors for intensive care unit admission, intensive care outcome, and post-intensive care survival in patients with de novo acute myeloid leukemia: a single center experience

“…In patients with AML, decreased fibrinogen levels are frequently associated with disseminated intravascular coagulation, which is known to be associated with an increased risk of severe bleeding. [34][35][36] Life-threatening bleeding was the second major reason for ICU admission in our cohort of AML patients, and was found to be associated with a poor outcome. Our observations are in line with previously published data showing that bleeding is one of the primary causes of an ICU admission in critically ill patients with hematologic malignancies, [37][38][39][40][41] and particularly in patients with AML.…”

Disseminated intravascular coagulation at diagnosis is a strong predictor for thrombosis in acute myeloid leukemia

“…10,[22][23][24] In previously published reports, the following risk factors for developing DIC were identified: high levels of C-reactive protein, high leukocyte counts, negative expressions of CD-13 and HLA-DR, and cytogenetics with a normal karyotype or 11q23 abnormality. 22 None of these previous studies reported on thrombosis or bleeding complications in relation to DIC. We found a comparable DIC incidence (8.5% younger cohort and 6.3% elderly cohort) in our series of patients.…”

Recombinant human thrombomodulin in the treatment of acute myeloid leukemia patients complicated by disseminated intravascular coagulation: retrospective analysis of outcomes between patients treated with heparin and recombinant human thrombomodulin therapy

“…DIC has often been associated with bleeding manifestations in AML cases, especially in APL cases [3][4][5][6][7][8]. DIC also occurs as a devastating complication in patients with other types of AML.…”

“…Although DIC also occurs as a devastating complication in patients with other types of acute myeloid leukemia (AML), it develops less frequently [3][4][5][6][7][8]. The release of procoagulant materials or enzymes from blasts or the fibrinolytic activity of leukemic cells themselves has been implicated in DIC [5,9,10].…”