Korean J Intern Med.  2015 Nov;30(6):884-890. 10.3904/kjim.2015.30.6.884.

Analysis of factors affecting hemorrhagic diathesis and overall survival in patients with acute promyelocytic leukemia

• Lee HJ
• Kim DH
• Lee S
• Koh MS
• Kim SY
• Lee JH
• Lee S
• Oh SY
• Han JY
• Kim HJ
• Kim SH

• KMID: 2381593
• DOI: http://doi.org/10.3904/kjim.2015.30.6.884

Abstract

BACKGROUND/AIMS
This study investigated whether patients with acute promyelocytic leukemia (APL) truly fulfill the diagnostic criteria of overt disseminated intravascular coagulation (DIC), as proposed by the International Society on Thrombosis and Haemostasis (ISTH) and the Korean Society on Thrombosis and Hemostasis (KSTH), and analyzed which component of the criteria most contributes to bleeding diathesis.
METHODS
A single-center retrospective analysis was conducted on newly diagnosed APL patients between January 1995 and May 2012.
RESULTS
A total of 46 newly diagnosed APL patients were analyzed. Of these, 27 patients (58.7%) showed initial bleeding. The median number of points per patient fulfilling the diagnostic criteria of overt DIC by the ISTH and the KSTH was 5 (range, 1 to 7) and 3 (range, 1 to 4), respectively. At diagnosis of APL, 22 patients (47.8%) fulfilled the overt DIC diagnostic criteria by either the ISTH or KSTH. In multivariate analysis of the ISTH or KSTH diagnostic criteria for overt DIC, the initial fibrinogen level was the only statistically significant factor associated with initial bleeding (p = 0.035), but it was not associated with overall survival (OS).
CONCLUSIONS
Initial fibrinogen level is associated with initial presentation of bleeding of APL patients, but does not affect OS.

Keyword

Leukemia, promyelocytic, acute; Disseminated intravascular coagulation; Fibrinogen

MeSH Terms

Adult
Aged
Biomarkers/blood
Chi-Square Distribution
Disseminated Intravascular Coagulation/blood/diagnosis/*etiology/mortality
Female
Fibrinogen/analysis
Hemorrhagic Disorders/blood/diagnosis/*etiology/mortality
Humans
Kaplan-Meier Estimate
Leukemia, Promyelocytic, Acute/blood/*complications/diagnosis/mortality
Logistic Models
Male
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Republic of Korea
Retrospective Studies
Risk Factors
Young Adult
Biomarkers
Fibrinogen