急性早幼粒细胞白血病患者静脉血栓栓塞的危险因素

Risk Factors for Venous Thromboembolism in Acute Promyelocytic Leukemia.

作者信息

Sabljic Nikica, Pantic Nikola, Virijevic Marijana, Rajic Jovan, Cvetkovic Mirjana, Trajkovic Lazar, Pravdic Zlatko, Bukumiric Zoran, Suvajdzic Vukovic Nada, Bogdanovic Andrija, Vidovic Ana, Todorovic Balint Milena, Bila Jelena, Lekovic Danijela, Djunic Irena, Antic Darko, Mitrovic Mirjana

机构信息

Clinic of Hematology, University Clinical Center of Serbia, 11000 Belgrade, Serbia.

Department of Internal Medicine, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.

出版信息

Cancers (Basel). 2024 Dec 17;16(24):4209. doi: 10.3390/cancers16244209.

DOI:10.3390/cancers16244209

PMID:39766107

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11674958/

Abstract

BACKGROUND

Acute promyelocytic leukemia (APL) is frequently associated with disseminated intravascular coagulation (DIC), leading to potentially life-threatening bleeding. Compared to bleeding, thromboses are a less commonly encountered problem.

OBJECTIVE

The objective of our study was to identify the incidence and predictive value of demographic data, clinical-laboratory parameters, and thrombosis risk assessment models (RAMs) for venous thromboembolism (VTE) in patients with APL.

METHODS

This study was a retrospective study conducted on adult patients with APL who were treated between 2006 and 2024 at the Clinic of Hematology UCCS with all-trans retinoic acid (ATRA) and anthracycline. The demographic and clinical-laboratory data related to VTE were collected and analyzed alongside the predictive value of two RAMs proposed by Al-Ani and Paterno and colleagues.

RESULTS

Among the one-hundred-fifty-five adult patients with APL, VTE was diagnosed in twenty-eight cases (18.1%). The most common location for thrombosis was in the central venous catheter (CVC), which affected twelve (42.8%) patients. A total of six (21.4%) patients had deep vein thrombosis (DVT), one patient (3.6%) showed a pulmonary embolism (PE), and thrombosis at unusual sites was present in nine (32.1%) patients. Our analyses showed that neither Al-Ani's RAM nor the RAM proposed by Paterno and colleagues were predictive for VTE in patients with APL. The C statistics value for the Al-Ani model was ROC = 0.514, and, for Paterno's RAM, it was ROC = 0.521. The independent risk factors for VTE, identified via multivariate analysis, were CD114 expression ( = 0.005, OR = 6.4 IC 95%: [1.8-23.2]) and the absence of bleeding at presentation ( = 0.013, OR = 0.086 IC 95%: [0.01-0.59]).

CONCLUSIONS

To the best of our knowledge, this is the first study showing that a higher expression of CD114 increases the risk of VTE. The absence of bleeding at presentation in patients with APL correlates with thrombosis. Further analyses are needed to confirm these findings and help to develop therapeutic strategies to prevent VTE complications. So far, no risk assessment model has been sufficient to stratify patients with APL according to their risk of VTE.

摘要

背景

急性早幼粒细胞白血病（APL）常与弥散性血管内凝血（DIC）相关，可导致危及生命的出血。与出血相比，血栓形成是较少见的问题。

目的

我们研究的目的是确定APL患者静脉血栓栓塞（VTE）的发生率以及人口统计学数据、临床实验室参数和血栓形成风险评估模型（RAMs）的预测价值。

方法

本研究是一项回顾性研究，对象为2006年至2024年期间在UCCS血液科接受全反式维甲酸（ATRA）和蒽环类药物治疗的成年APL患者。收集并分析与VTE相关的人口统计学和临床实验室数据，以及Al-Ani和Paterno及其同事提出的两个RAMs的预测价值。

结果

在155例成年APL患者中，28例（18.1%）诊断为VTE。血栓形成最常见的部位是中心静脉导管（CVC），累及12例（42.8%）患者。共有6例（21.4%）患者发生深静脉血栓形成（DVT），1例（3.6%）出现肺栓塞（PE），9例（32.1%）患者在不寻常部位出现血栓形成。我们的分析表明，Al-Ani的RAM和Paterno及其同事提出的RAM均不能预测APL患者的VTE。Al-Ani模型的C统计值为ROC = 0.514，Paterno的RAM的C统计值为ROC = 0.521。通过多变量分析确定的VTE独立危险因素为CD114表达（ = 0.005，OR = 6.4，95%CI：[1.8 - 23.2]）和就诊时无出血（ = 0.013，OR = 0.086，95%CI：[0.01 - 0.59]）。