The risk of thrombosis in patients with acute leukemia:: occurrence of thrombosis at diagnosis and during treatment
The risk of thrombosis in patients with acute leukemia:: occurrence of thrombosis at diagnosis and during treatment
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DOI：
10.1111/j.1538-7836.2005.01467.x
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发表时间：
2005-09-01
影响因子：
10.4
通讯作者：
Leone, G
中科院分区：
文献类型：
--
作者：
De Stefano, V;Sorà, F;Leone, G
背景：急性白血病尤其是急性淋巴细胞性白血病(ALL)经L-天门冬酰胺酶治疗后可发生血栓形成。然而，大多数报告都是轶事，关于急性髓细胞白血病(AML)血栓形成风险的数据很少。目的：评估急性白血病患者血栓形成的危险性。患者和方法：在1994年1月至2003年12月进行的一项观察性队列研究中，连续招募了379名新诊断的成人急性白血病患者。确诊ALL 69例，急性早幼粒细胞白血病(APL)31例，非M3型AML 279例。所有客观诊断的首次或复发症状性血栓栓塞症事件均被记录下来。结果：379例患者中有24例(6.3%；95%可信区间4.1%~9.2%)为首次血栓形成，80%为静脉血栓形成，20%为动脉血栓形成。确诊时，有13例(占整个队列的3.4%)表现为血栓：ALL占1.4%，APL占9.6%，非M3AML患者占3.2%。对343例确诊时无血栓形成的患者进行了随访，并记录了血栓事件(3.2%)。确诊后6个月，ALL患者血栓累积发生率为10.6%，APL患者为8.4%，非M3 AML患者为1.7%。接受L-天冬酰胺酶治疗的患者与未接受治疗的患者相比，血栓形成的风险增加了4.9倍(95%可信区间1.5-16.0)。血栓病死率为0.8%。结论：在急性白血病患者中，血栓形成的风险不可忽视。在APL(9.6%)和非M3型AML(3.2%)患者中，有很大一部分患者确诊时会出现血栓形成；在疾病的后续病程中也会出现类似的血栓形成。在所有患者中，确诊时症状性血栓形成的发生率相对较低(1.4%)，但在进一步治疗后显著增加，达到10.6%。在这种情况下，应该研究抗血栓预防的策略。
Background: Thromboernbolism can occur during acute leukemia, especially acute lymphoid leukemia (ALL) treated with L-asparaginase. Yet, most reports are anecdotical and scarce data are available on the risk of thrombosis in acute myeloid leukemia (AML). Objectives: To evaluate the risk of thrombosis in patients with acute leukemia. Patients and methods: Three-hundred and seventy-nine consecutive adult patients with newly diagnosed acute leukemia were recruited in an observational cohort study conducted from January 1994 to December 2003. Diagnosis was ALL in 69 patients, acute promyelocytic leukemia (APL; FAB subtype M3) in 31, and non-M3 AML in 279. All first or recurrent symptomatic thromboembolic events objectively diagnosed were recorded. Results: Twenty-four patients of the overall 379 (6.3%; 95% CI 4.1%-9.2%) had a first thrombosis, venous in 80% of the cases and arterial in 20%. At diagnosis, thrombosis was a presenting manifestation in 13 cases (3.4% of the whole cohort): 1.4% in ALL, 9.6% in APL, and 3.2% in non-M3 AML patients. Follow-up was carried out on 343 patients without thrombosis at diagnosis and further It thrombotic events (3.2%) were recorded. At 6 months from diagnosis, the cumulative incidence of thrombosis was 10.6% in ALL, 8.4% in APL, and 1.7% in non-M3 AML patients. The patients who received L-asparaginase had a 4.9-fold increased risk of thrombosis in comparison with those who did not (95% CI 1.5-16.0). The fatality rate due to thrombosis was 0.8%. Conclusions: In patients with acute leukemia, the risk of thrombosis is not negligible. Thombosis can be a presenting symptom at diagnosis in a significant portion of cases with APL (9.6%) and non-M3 AML (3.2%); a similar rate of thrombosis can occur during the subsequent course of the disease. The incidence of symptomatic thrombosis at diagnosis is relatively low in ALL patients (1.4%), but is significantly increased by further treatment up to 10.6%. Strategies of antithrombotic prophylaxis should be investigated in this setting.