急性早幼粒细胞白血病中的血栓形成事件
Thrombotic events in acute promyelocytic leukemia.
作者信息
Mitrovic Mirjana, Suvajdzic Nada, Elezovic Ivo, Bogdanovic Andrija, Djordjevic Valentina, Miljic Predrag, Djunic Irena, Gvozdenov Maja, Colovic Natasa, Virijevic Marijana, Lekovic Danijela, Vidovic Ana, Tomin Dragica
机构信息
Clinic of Hematology CCS, Belgrade, Koste Todorovica 2 Serbia.
Clinic of Hematology CCS, Belgrade, Koste Todorovica 2 Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8 Belgrade, Serbia.
出版信息
Thromb Res. 2015 Apr;135(4):588-93. doi: 10.1016/j.thromres.2014.11.026. Epub 2014 Dec 4.
INTRODUCTION
Thrombotic events (TE) appear to be more common in acute promyelocytic leukemia (APL) than in other acute leukemias, with reported prevalence ranging from 2 to 10-15%.
MATERIALS AND METHODS
We retrospectively analyzed the data on TE appearance in 63 APL patients.
RESULTS
TE occured in 13 (20.6%) cases, four arterial (6.3%) and nine venous (14.3%). TE were more frequently diagnosed after initiation of weekly D-dimer monitoring (7 TE during 20 months vs 6 during 76 months, P=0.032). Patients with and without venous thrombosis were significantly different regarding female/male ratio (P=0.046), PT (P=0.022), aPTT (P=0.044), ISTH DIC score (P=0.001), bcr3 (P=0.02) and FLT3-ITD (P=0.028) mutation. The most significant risk factor for venous TE occurrence in multivariate analysis was FLT3-ITD mutation (P=0.034). PAI-1 4G/4G polymorphism was five times more frequent in patients with venous TE than without it (P=0.05). Regarding risk factors for arterial TE we failed to identify any.
CONCLUSIONS
We have demonstrated that APL-related TE rate is higher than previously reported and that weekly D-dimer monitoring might help to identify patients with silent thrombosis. Moreover, our study suggests a possible relationship between venous TE occurrence and several laboratory findings (PT, aPTT, ISTH DIC score, bcr3 isoform, FLT3-ITD mutation and PAI 4G/4G). Prophylactic use of heparin might be considered in patients with ISTH DIC score<5, bcr3 isoform, FLT3-ITD mutation and PAI 4G/4G.
引言
血栓形成事件（TE）在急性早幼粒细胞白血病（APL）中似乎比在其他急性白血病中更为常见，报道的患病率在2%至10 - 15%之间。
材料与方法
我们回顾性分析了63例APL患者中TE出现的数据。
结果
13例（20.6%）发生TE，4例为动脉血栓（6.3%），9例为静脉血栓（14.3%）。在开始每周进行D - 二聚体监测后，TE更频繁被诊断出来（20个月内7例TE，而76个月内6例，P = 0.032）。有静脉血栓和无静脉血栓的患者在男女比例（P = 0.046）、PT（P = 0.022）、活化部分凝血活酶时间（aPTT）（P = 0.044）、国际血栓与止血学会（ISTH）弥散性血管内凝血（DIC）评分（P = 0.001）、bcr3（P = 0.02）和FMS样酪氨酸激酶3内部串联重复（FLT3 - ITD）突变方面存在显著差异。多因素分析中静脉TE发生的最显著危险因素是FLT3 - ITD突变（P = 0.034）。纤溶酶原激活物抑制剂 - 1（PAI - 1）4G/4G多态性在有静脉TE的患者中比无静脉TE的患者高五倍（P = 0.05）。关于动脉TE的危险因素，我们未能识别出任何因素。
结论
我们已证明与APL相关的TE发生率高于先前报道，并且每周进行D - 二聚体监测可能有助于识别无症状血栓形成的患者。此外，我们的研究表明静脉TE发生与一些实验室检查结果（PT、aPTT、ISTH DIC评分、bcr3亚型、FLT3 - ITD突变和PAI 4G/4G）之间可能存在关联。对于ISTH DIC评分<5、bcr3亚型、FLT3 - ITD突变和PAI 4G/4G的患者，可考虑预防性使用肝素。
Zotero 插件