Predictors of early hemorrhage in acute promyelocytic leukemia

Abstract

Fatal hemorrhage is the most common cause of induction failure and death among patients with acute promyelocytic leukemia (APL). However, there remains no established means of hemorrhagic risk stratification in APL. In this single center retrospective study of 43 patients treated for APL group-based trajectory modeling was used to identify laboratory trends associated with major bleeding. Bleeding risk was significantly associated with particular trends in white blood cell count (WBC) and lactate dehydrogenase level (LDH). Specifically, patients who presented with high WBC and/or LDH, and whose WBC and/or LDH then proceeded to uptrend during the initial days of induction, were significantly more likely to experience major bleeding (p = .0111 and p = .0143, respectively). Additionally, there appeared to be a temporal association between WBC and LDH trends and major bleeding events. Among nonlaboratory variables, differentiation syndrome (DS) was significantly associated with major bleeding (p = .00149).

Keywords:

• Acute promyelocytic leukemia
• hemorrhage
• disseminated intravascular coagulation
• white blood cell count
• lactate dehydrogenase
• differentiation syndrome

Potential conflict of interest

Disclosure forms provide by the authors are available with the full text of this article online at http:\\10.1080/10428194.2019.1581187.

Data availability statement

The data that support the findings of this study are openly available in OSF (DOI 10.17605/OSF.IO/4CHSB) at the link below:

https://osf.io/4chsb/?view_only=15de4d037a7342a8ae70a580e6cc4ba8

Additional information

Funding

No support for this work was received in the form of funding or grants.