Title

Risk Markers for Significant Bleeding and Thrombosis in Pediatric Acute Promyelocytic Leukemia; Report From the Children's Oncology Group Study AAML0631.

Document Type

Article

Publication Date

1-2019

Identifier

DOI: 10.1097/MPH.0000000000001280; PMCID: PMC6419515

Abstract

Acute promyelocytic leukemia (APL) is characterized by a heightened risk of coagulopathy with significant morbidity and mortality. Here we report our evaluation of presenting white blood cell (WBC) and the International Society on Thrombosis and Haemostasis (ISTH) disseminated intravascular coagulation (DIC) scoring system as markers for early death and nonlethal coagulopathy in pediatric APL. We evaluated 79 pediatric patients treated on a Children's Oncology Group phase III clinical trial. There were 4 early deaths and 13 nonlethal, clinically significant (grade III to IV) coagulopathy events during induction. Elevated presenting WBC was significantly associated with early death but not with both lethal and nonlethal coagulopathy events. An ISTH DIC score of ≥5 (the original ISTH criteria for overt DIC) was not associated with either early deaths or coagulopathy events. An ISTH DIC score threshold of 6, however, was significantly associated with early death (12% score ≥6 vs. 0% score <6) and with both lethal and nonlethal coagulopathy events (35% score ≥6 vs. 11% score <6). In pediatric APL patients, the presenting WBC is a marker for risk of early death. Although the ISTH score using a cutoff of ≥6 showed improved correlation with adverse coagulation events during induction, the sensitivity was only 70.6% (95% confidence interval, 44.0%-89.7%) and the specificity was 64.5% (95% confidence interval, 51.3%-76.3%). Thus, there is a strong need to identify other biomarkers that can predict APL-associated coagulopathy.

Journal Title

Journal of pediatric hematology/oncology : official journal of the American Society of Pediatric Hematology/Oncology

Volume

41

Issue

1

First Page

51

Last Page

55

MeSH Keywords

Adolescent; Biomarkers; Child; Child, Preschool; Disease-Free Survival; Female; Hemorrhage; Humans; Infant; Leukemia, Promyelocytic, Acute; Leukocyte Count; Male; Risk Factors; Survival Rate; Thrombosis

Keywords

Adolescent; Biomarkers; Child; Child, Preschool; Disease-Free Survival; Female; Hemorrhage; Humans; Infant; Leukemia, Promyelocytic, Acute; Leukocyte Count; Male; Risk Factors; Survival Rate; Thrombosis

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