Disseminated intravascular coagulation score evolution in 48 h predicts early death in acute promyelocytic leukemia patients.

Autor: Infante JB; Serviço de Hematologia e Transplantação de Medula, Centro Hospitalar Universitário Lisboa Norte-Hospital de Santa Maria, Lisboa, Portugal.; Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal.; Instituto de Medicina Molecular João Lobo Antunes, Lisboa, Portugal., Esteves GV; Serviço de Hematologia e Transplantação de Medula, Centro Hospitalar Universitário Lisboa Norte-Hospital de Santa Maria, Lisboa, Portugal.; Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal., Raposo J; Serviço de Hematologia e Transplantação de Medula, Centro Hospitalar Universitário Lisboa Norte-Hospital de Santa Maria, Lisboa, Portugal., de Lacerda JF; Serviço de Hematologia e Transplantação de Medula, Centro Hospitalar Universitário Lisboa Norte-Hospital de Santa Maria, Lisboa, Portugal.; Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal.; Instituto de Medicina Molecular João Lobo Antunes, Lisboa, Portugal.
Jazyk: angličtina
Zdroj: European journal of haematology [Eur J Haematol] 2024 May; Vol. 112 (5), pp. 840-844. Date of Electronic Publication: 2024 Feb 02.
DOI: 10.1111/ejh.14177
Abstrakt: Introduction: Early death (ED) is the unsolved issue of acute promyelocytic leukemia (APL). The disseminated intravascular coagulation (DIC) score has been proposed as a marker of bleeding and death in APL; whether its temporal evolution predicts outcomes in APL is unknown. We evaluated whether an increasing score 48 h after diagnosis associates with ED.
Methods: Retrospective, single-center study, including patients with newly diagnosed APL between 2000 and 2023, treated with all-transretinoic acid (ATRA) plus anthracycline or arsenic trioxide (ATO). "DIC score worsening" was defined as ≥1 point increase in the score after 48 h, and ED as death within 30 days of diagnosis.
Results: Eighty-six patients were included, with median age of 46 years (17-82). ED patients (26.7%) more frequently had age >60 years and worsening DIC score after 48 h. These were also the only predictors of ED identified in both univariate and multivariate (OR 4.18, p = .011; OR 7.8, p = .005, respectively) logistic regression analysis.
Conclusion: This is the first study on DIC score evolution in APL-a worsening DIC score 48 h after diagnosis is a strong independent predictive factor of ED. We propose a reduction of the DIC score from diagnosis as a new treatment goal in APL care.
(© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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