Factors associated with thrombo-hemorrhagic deaths in patients with Acute Promyelocytic leukemia treated with Arsenic Trioxide and all-trans retinoic acid.
Charanpreet SinghParathan KarunakaranUday YanamandraNishant JindalSaloni Rani KumarNeha SainiAditya JandialArihant JainDeepesh LadGaurav PrakashAlka KhadwalNarender KumarShano NaseemJasmina AhluwaliaNeelam VarmaSubhash VarmaPankaj MalhotraPublished in: Leukemia research (2023)
Acute Promyelocytic Leukemia (APL) is associated with excellent long-term outcomes. However, early mortality due to coagulopathy remains a challenge. In this study we examined the bleeding and thrombotic manifestations, as well as incidence of Early Death secondary to thrombosis/hemorrhage (ED-TH) in patients with APL. Early death (ED) was defined as death occurring within 30 days of induction therapy. Two-hundred forty-eight patients were included in the study. Overall, 57 patients had evidence of a major bleed/thrombosis at presentation or during induction therapy, including 44 patients with a major bleed, 8 patients with thrombosis and 5 patients with both evidence of thrombosis and a major bleed. Forty patients (16.1%) had ED, of which 21 had ED-TH. The cumulative incidence of death due to thrombo-hemorrhagic complications at 30 days was 8.4%. On univariate analysis, increasing Prothrombin time (PT)(p-<0.001), white blood cell count (p < 0.001) and activated Partial thromboplastin time (aPTT) (p < 0.001) were statistically significantly associated with increased risk of ED-TH. However, on multivariate analysis, only increasing PT (p-0.025) and aPTT (p-0.041) were significantly associated with increased risk of ED-TH.
Keyphrases
- emergency department
- end stage renal disease
- newly diagnosed
- ejection fraction
- chronic kidney disease
- pulmonary embolism
- prognostic factors
- risk factors
- peritoneal dialysis
- bone marrow
- acute myeloid leukemia
- type diabetes
- drinking water
- single cell
- atrial fibrillation
- heavy metals
- cell therapy
- cardiovascular events
- smoking cessation