Uchiumi Hideki, Matsushima Takafumi, Yamane Arito, Doki Noriko, Irisawa Hiroyuki, Saitoh Takayuki, Sakura Tohru, Jimbo Takahiro, Handa Hiroshi, Tsukamoto Norifumi, Karasawa Masamitsu, Miyawaki Shuichi, Murakami Hirokazu, Nojima Yoshihisa
Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Int J Hematol. 2007 Aug;86(2):137-42. doi: 10.1532/IJH97.06173.
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.
弥散性血管内凝血（DIC）是急性髓系白血病（AML）患者中发生的重要并发症之一。虽然急性早幼粒细胞白血病（APL）是DIC的一个强风险因素，但其他临床特征尚未完全明确。我们回顾性分析了161例连续的初发非APL AML成年患者。52例患者（32%）诊断为DIC；28例在诊断时，24例在诱导化疗开始后不久。DIC+组的白细胞计数、C反应蛋白和乳酸脱氢酶显著更高。CD13、CD19、CD34和HLA-DR的阴性表达在DIC+组中更常见。多因素逻辑回归分析显示，与DIC发生独立相关的变量为高C反应蛋白、高白细胞计数、CD13和HLA-DR的阴性表达以及核型正常或11q23异常的细胞遗传学。虽然DIC被认为与严重发病和偶尔的死亡相关，但我们未发现DIC+组和DIC-组在完全缓解率、总生存期或无病生存期方面有任何显著差异。本研究首次明确了非APL AML患者中与DIC相关的临床特征，但DIC确切的治疗方式和时机仍有待确定。
