1
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Sabljic N, Thachil J, Pantic N, Mitrovic M. Hemorrhage in acute promyelocytic leukemia-fibrinolysis in focus. Res Pract Thromb Haemost 2024; 8:102499. [PMID: 39130779 PMCID: PMC11314889 DOI: 10.1016/j.rpth.2024.102499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 05/23/2024] [Accepted: 06/13/2024] [Indexed: 08/13/2024] Open
Abstract
Coagulopathy continues to be a major challenge in the management of patients with acute promyelocytic leukemia (APL). Novel differentiating agents have led to improved survival in these patients, but perturbations in coagulation continue to have an impact on their prognosis. The most worrisome of coagulation disturbances is bleeding, which is not an uncommon cause of early death in APL. Despite this, there are no consistent predictors of this high risk of fatal hemorrhage in APL. In this context, the fibrinolytic system has been identified as a crucial role player in APL coagulopathy. However, the current guidelines for the management of APL give little regard to tests that measure the fibrinolytic system while giving more importance to close monitoring of conventional coagulation tests and platelet counts to identify the coagulopathy. More recently, viscoelastic tests have come to usefulness in determining global hemostasis and have been widely used for "diagnosing" hyperfibrinolysis in selected clinical settings. In this review, we attempt to describe risk assessment models for diagnosing APL coagulopathy, describe the possible application of viscoelastic tests in this setting, and persuade clinicians to reconsider the use of antifibrinolytics to improve survival of APL patients.
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Affiliation(s)
- Nikica Sabljic
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jecko Thachil
- Department of Hematology, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Nikola Pantic
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Mirjana Mitrovic
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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2
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Plant G, Kirton A, Guilcher GMT, AlNajjar M, Mah K, Mitha AP, Riva-Cambrin J, Steele M. Aortic Valve Thrombus, Stroke, and Endovascular Thrombectomy in a Child With APML and Trisomy 21. J Pediatr Hematol Oncol 2024; 46:272-274. [PMID: 38857164 DOI: 10.1097/mph.0000000000002858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 02/29/2024] [Indexed: 06/12/2024]
Abstract
APML, a subtype of acute myeloid leukemia, is highly curable, with cure rates over 90%. Despite its therapeutic success, APML poses elevated bleeding risks due to frequent prior disseminated intravascular coagulation. Less commonly recognized but critical is the thrombotic risk. We document a unique pediatric case: a 13-year-old with trisomy 21 diagnosed with APML had an asymptomatic aortic valve thrombus leading to thromboembolic arterial ischemic stroke. Through endovascular thrombectomy, cerebral circulation was re-established, extracting a fibrin thrombus with APML cells. Neurological recovery was swift. This report underscores the importance of vigilance for thrombotic complications in APML, highlighting the potential severity of overlooked risks.
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Affiliation(s)
- Gayathri Plant
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON
| | - Adam Kirton
- Departments of Pediatrics and Clinical Neurosciences
| | - Gregory M T Guilcher
- Pediatrics
- Sections of Pediatric Oncology and Blood and Marrow Transplant
- Oncology, Cumming School of Medicine
| | | | - Kandice Mah
- Section of Cardiology, BC Children's Hospital, Vancouver, BC, Canada
| | - Alim P Mitha
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary
| | - Jay Riva-Cambrin
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary
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3
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Mallah S, Owda F, Hamayel H, Enaya A, Mallah O, Abugaber D, Odeh R. Successful Management of Acute Promyelocytic Leukemia in a Patient Who Presented With Acute Ischemic Stroke on Top of Subdural Hematoma. Cureus 2023; 15:e45243. [PMID: 37842379 PMCID: PMC10576595 DOI: 10.7759/cureus.45243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
Acute promyelocytic leukemia (APL), a distinct subtype of acute myelogenous leukemia (AML), is commonly associated with a heightened risk of bleeding due to coagulopathy. Thrombotic events, although less frequent, have also been linked to APL. However, the occurrence of ischemic stroke as an initial presentation of APL, particularly concomitant with central nervous system (CNS) bleeding, is exceedingly rare. The combination of these two complications is not reported in APL patients and is anticipated to carry a high mortality rate even with treatment. In this report, we describe the case of a young female patient with no significant medical history, who presented with decreased consciousness and recurrent seizures. Brain magnetic resonance imaging (MRI) revealed the simultaneous occurrence of acute ischemic stroke and acute-on-chronic subdural hematoma. The subsequent bone marrow biopsy confirmed the diagnosis of APL, displaying the characteristic positive promyelocytic leukemia (PML)-retinoic acid receptor alpha (RARA) t(15;17) translocation. The patient was promptly initiated on a high-risk AML-M3 protocol, coupled with supportive treatment through platelet transfusion. Remarkably, a favorable response to treatment was observed, and a marked improvement in her neurological parameters was observed within 2 weeks duration of treatment. Subsequent assessment through a bone marrow biopsy one month later revealed complete remission, with the PML-RARA fusion gene becoming negative following a single course of consolidation therapy.
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Affiliation(s)
- Shatha Mallah
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | - Fahed Owda
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | - Hamza Hamayel
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, PSE
| | - Ahmad Enaya
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, PSE
| | - Osama Mallah
- Department of Radiology, An-Najah National University Hospital, Nablus, PSE
| | - Dina Abugaber
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, PSE
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | - Razan Odeh
- Department of Hemato-oncology, An-Najah National University Hospital, Nablus, PSE
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4
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Tondro Anamag F, Hashemi N, Sanaat Z, Khadivi Heris H, Moslemi M. Arteriovenous thrombosis, a complication of induction therapy with all-trans retinoic acid for acute promyelocytic leukemia: A case report. Clin Case Rep 2023; 11:e7856. [PMID: 37720706 PMCID: PMC10500047 DOI: 10.1002/ccr3.7856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/15/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
We report a case of arterial and venous thrombosis during induction therapy. This case emphasizes considering some degree of caution for thrombotic events in APL patients which was represented in our case as abdominal pain. Rapid initiation of anticoagulation and preventive measures is suggested for better management of the condition.
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Affiliation(s)
- Farhad Tondro Anamag
- Hematology and Oncology Research CenterTabriz University of medical sciencesTabrizIran
| | - Negin Hashemi
- Department of Pharmacology and Toxicology, Faculty of PharmacyTabriz University of medical sciencesTabrizIran
| | - Zohreh Sanaat
- Hematology and Oncology Research CenterTabriz University of medical sciencesTabrizIran
| | | | - Mohammadreza Moslemi
- Hematology and Oncology Research CenterTabriz University of medical sciencesTabrizIran
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5
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Zheng W, Zhang Y, Gao M, Qiu M. Emerging 2D pnictogens: a novel multifunctional photonic nanoplatform for cutting-edge precision treatment. Chem Commun (Camb) 2023; 59:10205-10225. [PMID: 37555438 DOI: 10.1039/d3cc02624h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
The elements of the pnictogen group, known as the 15th (VA) family in the periodic table, including phosphorus (P), arsenic (As), antimony (Sb) and bismuth (Bi), have been widely used by alchemists to treat various diseases since ancient times and hold a pivotal position in the history of medicine, owing to their diverse pharmacological activities. Recently, with the development of modern nanotechnology, pnictogen group elements appear in a more innovative form, namely two-dimensional (2D) pnictogens (i.e. phosphorene, arsenene, and bismuthene) with a unique layered crystal structure and extraordinary optoelectronic characteristics, which endow them with significant superiority as a novel multifunctional photonic nanoplatform for cutting-edge precision treatment of various diseases. The puckered layer structure with ultralarge surface area make them ideal drug and gene delivery vectors that can avoid degradation and reduce target effects. The anisotropic morphology allows their easier internalization by cells and may improve gene transfection efficiency. Tunable optoelectronic characteristics endow them with excellent phototherapy performance as well as the ability to act as an optical switch to initiate subsequent therapeutic events. This review provides a brief overview of the properties, preparation and surface modifications of 2D pnictogens, and then focuses on its applications in cutting-edge precision treatment as a novel multifunctional photonic nanoplatform, such as phototherapy, photonic medicine, photo-adjuvant immunotherapy and photo-assisted gene therapy. Finally, the challenges and future development trends for 2D pnictogens are provided. With a focus on 2D pnictogen-based multifunctional photonic nanoplatforms, this review may also provide profound insights for the next generation innovative precision therapy.
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Affiliation(s)
- Wenjing Zheng
- Key Laboratory of Marine Chemistry Theory and Technology (Ocean University of China), Ministry of Education, Qingdao 266100, China.
| | - Yifan Zhang
- Key Laboratory of Marine Chemistry Theory and Technology (Ocean University of China), Ministry of Education, Qingdao 266100, China.
| | - Ming Gao
- Key Laboratory of Marine Chemistry Theory and Technology (Ocean University of China), Ministry of Education, Qingdao 266100, China.
| | - Meng Qiu
- Key Laboratory of Marine Chemistry Theory and Technology (Ocean University of China), Ministry of Education, Qingdao 266100, China.
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6
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Stupakova Z, Diagil I, Melnyk U, Karnabeda O, Sergeieva A. Primary hemostasis dysfunctions and bleeding risk in newly diagnosed acute myeloid leukemia. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04751-w. [PMID: 37060474 DOI: 10.1007/s00432-023-04751-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/06/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Acute myeloid leukaemia carries the risk of complications associated with dysfunctions in haemostasis system. The purpose of this study was to investigate the factors associated with the risk of bleeding in patients with newly diagnosed acute myeloid leukaemia (AML). METHODS This study involved the methods of immunoenzymatic analysis and classical coagulation studies. The number of biochemical parameters important for establishing coagulative dysfunction in acute myeloid leukaemia was determined, the main ones being the level of von Willebrand factor, the Ristocetin-cofactor activity of von Willebrand factor and factor VIII activity, prothrombin time, platelet count, and fibrinogen concentration. RESULTS According to the results of the present study, the reduced activity of von Willebrand factor in patients with AML was associated with severe bleeding. The authors observed an increase in the number of platelets count in patients with AML who experienced haemorrhages compared to patients with no bleeding signs. The study also established an increase in the concentration of fibrinogen in cancer patients, compared to the control sample. Symptoms and quantitative indicators for diagnosing the severity of haemorrhagic syndrome were grouped. The authors considered the advantages and disadvantages of many therapeutic preparations and focussed on specific markers of activated haemorrhage-predicting platelets. CONCLUSION Further studies concern the search for effective markers and therapeutic approaches to minimize haemorrhagic syndrome. The results were statistically processed using the functions ANOVA, t test, CORREL, determination of the value of reliability, and mean square deviation.
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Affiliation(s)
- Zinaida Stupakova
- Department of Radiologic Hematology, National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine.
| | - Iryna Diagil
- Department of Radiologic Hematology, National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | | | | | - Anna Sergeieva
- Department of Radiologic Hematology, National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
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7
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Roy PS, Munikoty V, Trehan A, Jain R, Bhatia P, Naseem S, Varma N, Bansal D. Early mortality continues to be a barrier to excellent survival in childhood acute promyelocytic leukemia: a retrospective study of 62 patients spanning 17 years. Pediatr Hematol Oncol 2023; 40:117-130. [PMID: 35849424 DOI: 10.1080/08880018.2022.2082610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Data on childhood acute promyelocytic leukemia (APL) from low-and middle-income countries is limited. Early mortality is a concern and often not highlighted in clinical trials. The retrospective study was conducted on patients (≤12 years) with APL from 2003 to 2021 at a single center in India. Patients were treated with all-trans-retinoic acid (ATRA) and chemotherapy. Induction and three courses of consolidation were followed by maintenance for 2 years. In 2015, the protocol was updated with following modifications: (a) obtaining diagnostic cerebrospinal fluid at end-of-induction rather than at diagnosis, (b) administering intrathecal cytarabine regardless of risk-category, (c) risk-stratified administration of chemotherapy, and (d) inclusion of ATRA in all the cycles of consolidation. Sixty-two patients were diagnosed over the 17 years. The median age was 8 years (range: 0.9-12). Half had high-risk disease. Differentiation syndrome was observed in 32%, none being fatal. Eighteen (29%) patients died due to hemorrhage (83%) or septicemia (17%). Thirteen (21%) had early mortality (≤15 days), all due to hemorrhage. A platelet count <20 × 109/L predicted early mortality (odds ratio: 4.5; 95% CI: 0.9-22, p = 0.06). Treatment abandonment reduced from 23.5% during 2003-2015 to nil during 2015-2021 (p = 0.006). Three (8%) patients relapsed. The 4-year OS of all patients and the patients who survived >15 days was 70.1% and 89.6%, respectively. The 4-year EFS, including abandonment and early mortality, before and following updated protocol, was 61.4% and 65.5%, respectively (p = 0.77). Early mortality continues to be a barrier to an otherwise excellent survival in childhood APL. A significant reduction in treatment abandonment in recent years is gratifying.
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Affiliation(s)
- Pritam Singha Roy
- Department of Pediatrics, Advanced Pediatrics Center, Hematology-Oncology Unit, Chandigarh, India
| | - Vinay Munikoty
- Department of Pediatrics, Advanced Pediatrics Center, Hematology-Oncology Unit, Chandigarh, India
| | - Amita Trehan
- Department of Pediatrics, Advanced Pediatrics Center, Hematology-Oncology Unit, Chandigarh, India
| | - Richa Jain
- Department of Pediatrics, Advanced Pediatrics Center, Hematology-Oncology Unit, Chandigarh, India
| | - Prateek Bhatia
- Department of Pediatrics, Advanced Pediatrics Center, Hematology-Oncology Unit, Chandigarh, India
| | - Shano Naseem
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Department of Pediatrics, Advanced Pediatrics Center, Hematology-Oncology Unit, Chandigarh, India
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8
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Coagulopathy in Patients with Low/Intermediate Risk Acute Promyelocytic Leukemia treated with First Line Arsenic Trioxide in Combination with All-Trans Retinoic Acid: A Monocentric Experience. Mediterr J Hematol Infect Dis 2023; 15:e2023009. [PMID: 36660356 PMCID: PMC9833308 DOI: 10.4084/mjhid.2023.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/22/2022] [Indexed: 01/03/2023] Open
Abstract
No abstract
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9
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Liu G, Liu L, Bartolo DD, Li KY, Li X. Acute Promyelocytic Leukemia with Rare Genetic Aberrations: A Report of Three Cases. Genes (Basel) 2022; 14:genes14010046. [PMID: 36672788 PMCID: PMC9858271 DOI: 10.3390/genes14010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/12/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
Acute promyelocytic leukemia (APL) is a unique subtype of acute myeloid leukemia (AML) that is characterized by the PML::RARA fusion or, more rarely, a variant RARA translocation. While APL can be clinically suspected, diagnosis of APL requires genetic confirmation. Targeted therapy such as all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO) has dramatically improved the prognosis of APL patients, but this is dependent on timely genetic testing as different fusions and/or mutations can affect therapeutic outcomes. Here we report three APL cases with various genetic aberrations: cryptic PML::RARA fusion, variant RARA rearrangement, and typical PML::RARA fusion with co-existing FLT3-ITD mutation. They serve to illustrate the utility of integrating genetic testing, using chromosome analysis, fluorescence in situ hybridization (FISH), reverse transcriptase-polymerase chain reaction (RT-PCR), and next-generation sequencing (NGS) in providing a detailed understanding of the genetic alterations underlying each patient's disease.
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Affiliation(s)
- Guang Liu
- Genetics/Genomics Division, Sonora Quest Laboratories, University of Arizona College of Medicine, Phoenix, AZ 85034, USA
- Correspondence: (G.L.); (X.L.)
| | - Lanting Liu
- AmeriPath Indiana, Indianapolis, IN 46219, USA
| | | | - Katie Y. Li
- Boston University School of Medicine and Boston Medical Center, Boston, MA 02118, USA
| | - Xia Li
- Department of Pathology, University of Arizona College of Medicine, Sonora Quest Laboratories, Phoenix, AZ 85034, USA
- Correspondence: (G.L.); (X.L.)
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10
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Naicker W, Kloppers J, van Rooyen FC, van Marle A, Barrett C. Acute promyelocytic leukaemia: A central South African experience. SOUTH AFRICAN JOURNAL OF ONCOLOGY 2022. [DOI: 10.4102/sajo.v6i0.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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11
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Chang JC. Novel Classification of Thrombotic Disorders Based on Molecular Hemostasis and Thrombogenesis Producing Primary and Secondary Phenotypes of Thrombosis. Biomedicines 2022; 10:2706. [PMID: 36359229 PMCID: PMC9687744 DOI: 10.3390/biomedicines10112706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/26/2022] [Accepted: 10/11/2022] [Indexed: 09/29/2023] Open
Abstract
Thrombosis, the common and deadliest disorder among human diseases, develops as a result of the intravascular hemostasis following an intravascular injury, which can be caused by a variety of trauma, non-traumatic insults or clinical illnesses. Thrombosis can occur at any location of the vascular system supplied by blood from the heart to large and smallest arterial and venous systems and may affect the function and anatomy of the organ and tissue. It more commonly occurs in the smaller circulatory system of the vascular tree such as arterioles and capillaries, and venules of the organs, especially in the brain, lungs, heart, pancreas, muscle and kidneys, and sinusoids of the liver. Thrombosis has been referred as the disease of "blood clots", which concept is incompletely defined, but represents many different hemostatic diseases from microthrombosis to fibrin clot disease, macrothrombosis, and combined micro-macrothrombosis. Thrombosis is produced following an intravascular injury via one or more combination of four different mechanisms of thrombogenesis: microthrombogenesis, fibrinogenesis, macrothrombogenesis and micro-macrothrombogenesis initiated by normal physiological hemostasis in vivo. The clinical phenotype expression of thrombosis is determined by: (1) depth of the intravascular wall injury, (2) extent of the injury affecting the vascular tree system, (3) physiological character of the involved vascular system, (4) locality of the vascular injury, and (5) underlying non-hemostatic conditions interacting with hemostasis. Recent acquisition of "two-path unifying theory" of hemostasis and "two-activation theory of the endothelium" has opened a new frontier in science of medicine by identifying the pathophysiological mechanism of different thrombotic disorders and also contributing to the better understanding of many poorly defined human diseases, including different phenotypes of stroke and cardiovascular disease, trauma, sepsis and septic shock, multiorgan dysfunction syndrome, and autoimmune disease, and others. Reviewed are the fundamentals in hemostasis, thrombogenesis and thrombosis based on hemostatic theories, and proposed is a novel classification of thrombotic disorders.
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Affiliation(s)
- Jae Chan Chang
- Department of Medicine, School of Medicine, University of California Irvine School of Medicine, Irvine, CA 92868, USA
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12
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Shu X, Wu Q, Guo T, Yin H, Liu J. Acute Promyelocytic Leukemia Presenting With a Myeloid Sarcoma of the Spine: A Case Report and Literature Review. Front Oncol 2022; 12:851406. [PMID: 35311073 PMCID: PMC8931201 DOI: 10.3389/fonc.2022.851406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/07/2022] [Indexed: 12/26/2022] Open
Abstract
Myeloid sarcoma is a rare extramedullary tumor of immature myeloid cells. Certain known acute myeloid leukemia cytogenetic abnormalities, in particular t(8,21), has been associated with a higher incidence. Myeloid sarcoma, which rarely happens in acute promyelocytic leukemias, is more common in recurrent patients after the advent of all-trans retinoic acid (ATRA) and are rare in untreated acute promyelocytic leukemia. We described a case of, to our knowledge, de novo myeloid sarcoma of the spine confirmed as acute promyelocytic leukemia. Myeloid sarcoma is diagnosed by spinal tumor biopsy, and microscopic examination of a bone marrow smear and cytogenetic analysis led to a confirmed diagnosis of acute promyelocytic leukemia.
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13
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Fodil S, Arnaud M, Vaganay C, Puissant A, Lengline E, Mooney N, Itzykson R, Zafrani L. Endothelial cells: major players in acute myeloid leukaemia. Blood Rev 2022; 54:100932. [DOI: 10.1016/j.blre.2022.100932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 12/17/2022]
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14
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Hasegawa T, Kanayama T, Komatsu H. Acute promyelocytic leukemia complicated by iliac subperiosteal hematoma. Pediatr Int 2022; 64:e15078. [PMID: 35313043 DOI: 10.1111/ped.15078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/04/2021] [Accepted: 11/25/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Tomohiro Hasegawa
- Department of Pediatrics, National Hospital Organization Maizuru Medical Center, Maizuru, Japan
| | - Takuyo Kanayama
- Department of Pediatrics, National Hospital Organization Maizuru Medical Center, Maizuru, Japan
| | - Hiroshi Komatsu
- Department of Pediatrics, National Hospital Organization Maizuru Medical Center, Maizuru, Japan
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15
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Sabljic N, Pantic N, Virijevic M, Bukumiric Z, Novakovic T, Pravdic Z, Rajic J, Vidovic A, Suvajdzic N, Jaradeh M, Fareed J, Antic D, Mitrovic M. Application of Rotational Thromboelastometry in Patients with Acute Promyelocytic Leukemia. Clin Appl Thromb Hemost 2022; 28:10760296221119809. [PMID: 35942712 PMCID: PMC9373117 DOI: 10.1177/10760296221119809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Hemorrhagic early death (HED) remains a major cause of treatment failure
among patients with acute promyelocytic leukemia (APL). We aimed to
investigate the prognostic potential of rotational thromboelastometry
(ROTEM) for bleeding in patients with APL. Materials and Methods 31 newly-diagnosed APL patients (median age of 40 years; 14 female/17 male)
that underwent treatment at the Clinic of Hematology UCCS from 2016-2020
with all-trans retinoic acid and anthracyclines were recruited. CBCs
(complete blood count), conventional coagulation tests (CCTs), and ROTEM
parameters obtained before treatment initiation were evaluated. Results All patients demonstrated at least one ROTEM parameter out of the reference
range. ROTEM parameters associated with significant hemorrhage were EXTEM
clotting time (CT) (P = 0.041) and INTEM amplitude 10 (A10) (P = 0.039),
however, only EXTEM CT (P = 0.036) was associated with HED. Among CBCs and
CCTs, only platelets were associated with significant bleeding (P = 0.015),
while D-dimer was associated with both bleeding and HED (P = 0.001 and
P = 0.002, respectively). Conclusion Our results indicate that ROTEM parameters may reveal hypocoagulability in
APL patients and have the potential to improve current hemorrhage prognostic
methods. Additionally, these results suggest the combination of ROTEM and
CCTs might be useful in identifying patients at risk for HED.
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Affiliation(s)
- Nikica Sabljic
- Clinic of Hematology, 63740University Clinical Center of Serbia, Belgrade, Serbia
| | - Nikola Pantic
- Clinic of Hematology, 63740University Clinical Center of Serbia, Belgrade, Serbia
| | - Marijana Virijevic
- Clinic of Hematology, 63740University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, 54801University of Belgrade, Belgrade, Serbia
| | - Zoran Bukumiric
- Faculty of Medicine, 54801University of Belgrade, Belgrade, Serbia.,Faculty of Medicine, Institute for medical statistics and informatics, 54801University of Belgrade, Beograd, Serbia
| | - Tina Novakovic
- Clinic of Vascular Surgery, 63740University Clinical Center of Serbia, Belgrade, Serbia
| | - Zlatko Pravdic
- Clinic of Hematology, 63740University Clinical Center of Serbia, Belgrade, Serbia
| | - Jovan Rajic
- Clinic of Hematology, 63740University Clinical Center of Serbia, Belgrade, Serbia
| | - Ana Vidovic
- Clinic of Hematology, 63740University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, 54801University of Belgrade, Belgrade, Serbia
| | - Nada Suvajdzic
- Clinic of Hematology, 63740University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, 54801University of Belgrade, Belgrade, Serbia
| | - Mark Jaradeh
- Department of Molecular Pharmacology & Neuroscience, 25815Loyola University Medical Center, Maywood, USA
| | - Jawed Fareed
- Department of Molecular Pharmacology & Neuroscience, 25815Loyola University Medical Center, Maywood, USA
| | - Darko Antic
- Clinic of Hematology, 63740University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, 54801University of Belgrade, Belgrade, Serbia
| | - Mirjana Mitrovic
- Clinic of Hematology, 63740University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, 54801University of Belgrade, Belgrade, Serbia
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16
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Siegal T, Benouaich-Amiel A, Bairey O. Neurologic complications of acute myeloid leukemia. Diagnostic approach and therapeutic modalities. Blood Rev 2021; 53:100910. [PMID: 34836656 DOI: 10.1016/j.blre.2021.100910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 12/17/2022]
Abstract
Acute myeloid leukemia (AML) comprises a heterogeneous group of aggressive blood malignancies that arise from clonal expansion of malignant hematopoietic precursor cells in the bone marrow. Neurologic manifestations of these malignancies are manifolds. AML is the most common form of acute leukemia in adults and this review describes the neurologic complications in this age group. Neurologic symptoms and signs may develop in AML either from a direct neoplastic involvement of the central or the peripheral nervous system or as an indirect effect of the disease process. Direct involvement of the nervous system includes invasion of the central or the peripheral nervous system (parenchymal and leptomeningeal dissemination, myeloid sarcoma, neuroleukemiosis). Thrombotic and hemorrhagic events are common manifestations of indirect involvement of the nervous system and they are the outcome of hyperleukocytosis, thrombocytopenia and coagulopathy. Many neurologic complications are iatrogenic and include diverse categories such as lumbar puncture and intrathecal or systemic chemotherapy and targeted therapies, radiotherapy and allogeneic stem cell transplantation. Most neurologic manifestations require urgent treatment and confer a poor prognosis. This review describes the neurologic complications of acute myeloid malignancies in the era of contemporary treatment. Those manifestations require expert consideration of their origin as they are being identified with increasing frequency as patients survive longer.
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Affiliation(s)
- Tali Siegal
- Neuro-Oncology Center, Davidoff Institute of Oncology, Rabin Medical Center, Petach Tiqva, Israel; Hebrew University, Jerusalem, Israel.
| | | | - Osnat Bairey
- Hematology Institute, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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Varghese C, Liu VY, Immanuel T, Chien N, Green T, Chan G, Theakston E, Kalev-Zylinska M. Ethnic differences in acute promyelocytic leukaemia between New Zealand Polynesian and European patients. ACTA ACUST UNITED AC 2021; 26:215-224. [PMID: 33594940 DOI: 10.1080/16078454.2021.1882146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Ethnic differences in haematologic malignancies remain poorly elucidated, hence research in this area is important. This was a retrospective study into potential ethnic disparity in the presentation and outcomes of acute promyelocytic leukaemia (APL) between New Zealand (NZ) Polynesian and European patients. Data were analysed for patients treated at Auckland City Hospital (ACH; n = 55) and recorded in the New Zealand Cancer Registry (NZCR; n = 173), both for the period 2000-2017. We found that Polynesian patients treated at ACH presented at a younger age than European (P = 0.005), showed higher blast counts (P = 0.033), and a marginally higher prothrombin ratio (P = 0.02). Treatment with all-trans retinoic acid (ATRA) was started faster in Polynesian patients than European (P = 0.021), suggesting Polynesians were sicker at presentation but were managed accordingly. There were no differences in bleeding events, transfusion requirements and early deaths during the first month of treatment. Long-term survival was also similar. Data extracted from the NZCR confirmed NZ Polynesian patients with APL were younger than European (P < 0.001), but long-term survival was similar (P = 0.920). In summary, this study indicates a discrepancy in the presentation and severity of APL between NZ Polynesian and European patients but treatment initiation was rapid with no difference in outcomes. The distinctive features of APL in NZ Polynesians raise the possibility of a predisposing genetic factor or a different risk factor profile, elucidation of which is important for all patients with APL.
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Affiliation(s)
- Chris Varghese
- Blood and Cancer Biology Laboratory, Department of Molecular Medicine & Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | | | - Tracey Immanuel
- Blood and Cancer Biology Laboratory, Department of Molecular Medicine & Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Nicole Chien
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand.,Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Taryn Green
- Blood and Cancer Biology Laboratory, Department of Molecular Medicine & Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - George Chan
- Blood and Cancer Biology Laboratory, Department of Molecular Medicine & Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand.,Department of Haematology, Auckland City Hospital, Auckland, New Zealand.,Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Edward Theakston
- Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Maggie Kalev-Zylinska
- Blood and Cancer Biology Laboratory, Department of Molecular Medicine & Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand.,Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand
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18
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Zhao H, Sun J, Yan L, Jin B, Hou W, Cao F, Li H, Zhou J, Zhang Y. Tissue factor-bearing microparticles are a link between acute promyelocytic leukemia cells and coagulation activation: a human subject study. Ann Hematol 2021; 100:1473-1483. [PMID: 33893844 DOI: 10.1007/s00277-021-04533-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 04/12/2021] [Indexed: 11/26/2022]
Abstract
Acute promyelocytic leukemia (APL) cells constitutively express a large amount of tissue factor (TF) antigen, most of which is present in the cytoplasm. Coagulopathy may persist after induction therapy. We evaluated the overall role of circulating microparticles (MPs) in coagulation activation in APL-associated coagulopathy before and during induction therapy. Eleven adult patients with ≥ World Health Organization's (WHO) grade 2 bleeding events and 11 sex- and age-matched healthy controls were selected. All patients received arsenic trioxide alone as induction therapy. MP-associated TF (MP-TF) activity and MP procoagulant activity (MP-PCA) and 12 coagulation- and anticoagulation-associated indexes were measured before, during, and after induction therapy. Correlation between MP-associated indexes and the other 12 indexes was analyzed in patients. The MP-TF activity was negligible in controls, whereas it markedly increased in patients, dropped rapidly after treatment, and returned to normal at the end of induction therapy. The MP-PCA was similar between patients and controls. The correlation analysis revealed that TF-bearing MPs in patients mainly originated from APL cells. Partially differentiated APL cells could also release TF-bearing MPs, and the higher the degree of APL cell differentiation, the lower the ability of APL cells to release TF-bearing MPs. MP-TF was the main source of active TF in plasma and an important contributor for the coagulation activation in APL-associated coagulopathy. It was MPs released by APL cells/partially differentiated APL cells that served as the vehicle to transfer the large amount of TF to plasma to activate coagulation.
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Affiliation(s)
- Hongli Zhao
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
- Department of Hematology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
| | - Jiayue Sun
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
| | - Liru Yan
- Department of Carders Outpatient Service, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
| | - Bo Jin
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
| | - Wenyi Hou
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
| | - Fenglin Cao
- Department of Central Laboratory, The First Affiliated Hospital of Harbin Medical University, No. 23, Youzheng Street, Nangang District, Harbin, 150001, People's Republic of China
| | - Haitao Li
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
| | - Jin Zhou
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
- Department of Central Laboratory, The First Affiliated Hospital of Harbin Medical University, No. 23, Youzheng Street, Nangang District, Harbin, 150001, People's Republic of China
| | - Yingmei Zhang
- Department of Central Laboratory, The First Affiliated Hospital of Harbin Medical University, No. 23, Youzheng Street, Nangang District, Harbin, 150001, People's Republic of China.
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19
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Ten Cate H, Leader A. Management of Disseminated Intravascular Coagulation in Acute Leukemias. Hamostaseologie 2021; 41:120-126. [PMID: 33860520 DOI: 10.1055/a-1393-8302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Disseminated intravascular coagulation (DIC) is characterized by the intravascular activation of coagulation with loss of localization arising from different causes, and is diagnosed using scoring systems which rely upon the presence of an underlying disorder compatible with DIC alongside hemostatic derangements such as low platelet count, prolonged prothrombin time, and elevated fibrinogen degradation products. DIC is common in patients with acute leukemia, with prevalence ranging from 17 to 100% in acute promyelocytic leukemia (APL) and 8.5 to 25% in acute lymphoblastic leukemia (ALL) and non-APL acute myeloid leukemia (AML). The pathophysiology is complex and varies between the leukemia subtypes, and is not fully reflected by the laboratory markers currently used to classify DIC. Similarly, the clinical consequence of DIC in acute leukemia also varies across the types of leukemia. DIC is primarily associated with bleeding in APL, while thrombosis is the dominant phenotype in ALL and non-APL AML. The cornerstone of managing DIC is the treatment of the underlying disease, as exemplified by the important role of early administration of all-trans retinoic acid in APL. Other aspects of management focus on supportive care aimed at minimizing the risk of bleeding, via transfusion of blood products. The use of blood products is more liberal in APL, due to the hemorrhagic phenotype and unacceptably high rates of early hemorrhagic death. This review will focus on the pathophysiology, risk factors, clinical implications, and the management of DIC in patients across the spectrum of acute leukemias.
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Affiliation(s)
- Hugo Ten Cate
- Department of Internal Medicine and Thrombosis Expert Center, Maastricht University Medical Center, Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Avi Leader
- CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Hematology Institute, Rabin Medical Center, Petah Tikva, Israel
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20
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Farmer I, Okikiolu J, Steel M, Wanniarachchi C, Littlewood S, Gupta S, Thanigaikumar M, Oram SH, Moonim M, Kulasekararaj AG, Yeghen T. Acute promyelocytic leukaemia lying under the mask of COVID-19-a diagnostic and therapeutic conundrum. Br J Haematol 2020; 190:e248-e250. [PMID: 32428243 PMCID: PMC7276820 DOI: 10.1111/bjh.16864] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Isabel Farmer
- Department of Haematology, Lewisham and Greenwich NHS Trust, London, UK
| | - Jumoke Okikiolu
- Department of Haematology, Lewisham and Greenwich NHS Trust, London, UK
| | - Matthew Steel
- Department of Haematology, Lewisham and Greenwich NHS Trust, London, UK
| | | | - Shona Littlewood
- Department of Haematology, Lewisham and Greenwich NHS Trust, London, UK
| | - Sunil Gupta
- Department of Haematology, Lewisham and Greenwich NHS Trust, London, UK
| | | | - S Helen Oram
- Department of Haematology, Lewisham and Greenwich NHS Trust, London, UK
| | - Mufaddal Moonim
- Department of Histopathology, Guys and St Thomas NHS Foundation Trust, London, UK
| | | | - Tullie Yeghen
- Department of Haematology, Lewisham and Greenwich NHS Trust, London, UK
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21
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Baldacini M, Pop R, Sattler L, Mauvieux L, Bilger K, Gantzer J, Schneider F, Beaujeux R, Simand C, Herbrecht R. Concomitant haemorrhagic syndrome and recurrent extensive arterial thrombosis in a patient with COVID-19 and acute promyelocytic leukaemia. Br J Haematol 2020; 189:1054-1056. [PMID: 32369614 PMCID: PMC7267249 DOI: 10.1111/bjh.16768] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Mathieu Baldacini
- Service de Médecine Intensive et Réanimation, University Hospitals of Strasbourg, Strasbourg, France
| | - Raoul Pop
- Service de Neuroradiologie Interventionnelle, University Hospitals of Strasbourg, Strasbourg, France
| | - Laurent Sattler
- Laboratoire d'Hématologie, University Hospitals of Strasbourg, Strasbourg, France
| | - Laurent Mauvieux
- Laboratoire d'Hématologie, University Hospitals of Strasbourg, Strasbourg, France
| | - Karin Bilger
- Département d'Oncologie et Hématologie, Institut de Cancérologie Strasbourg. Europe (ICANS), Strasbourg, France
| | - Justine Gantzer
- Département d'Oncologie et Hématologie, Institut de Cancérologie Strasbourg. Europe (ICANS), Strasbourg, France
| | - Francis Schneider
- Service de Médecine Intensive et Réanimation, University Hospitals of Strasbourg, Strasbourg, France
| | - Remy Beaujeux
- Service de Neuroradiologie Interventionnelle, University Hospitals of Strasbourg, Strasbourg, France
| | - Célestine Simand
- Département d'Oncologie et Hématologie, Institut de Cancérologie Strasbourg. Europe (ICANS), Strasbourg, France
| | - Raoul Herbrecht
- Département d'Oncologie et Hématologie, Institut de Cancérologie Strasbourg. Europe (ICANS), Strasbourg, France
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22
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Naymagon L, Mascarenhas J. Hemorrhage in acute promyelocytic leukemia: Can it be predicted and prevented? Leuk Res 2020; 94:106356. [PMID: 32445941 DOI: 10.1016/j.leukres.2020.106356] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/11/2020] [Accepted: 04/17/2020] [Indexed: 12/13/2022]
Abstract
Hemorrhagic death is the leading cause of treatment failure in acute promyelocytic leukemia (APL). Our ability to identify patients at greatest risk of hemorrhage, and to actively prevent hemorrhage, remains limited. Nevertheless, some data is available to guide contemporary clinical practice and future investigation. Circulating disease burden, best represented by the peripheral WBC / blast count, is the most consistent predictor of major and fatal bleeding risk. In contrast, laboratory markers of disseminated intravascular coagulation (DIC) appear to be poor predictors. A number of interventions have been posited to reduce bleeding risk. Prompt initiation of all-trans retinoic acid (ATRA), avoidance of invasive procedures, transfusion support, and cytoreduction all have theoretical merit. Though they lack strong evidence to support their benefit with respect to bleeding, they are associated with limited risks, and are therefore advisable. Low-dose therapeutic heparin and antifibrinolytics have not shown the ability to positively modify bleeding risk, and heparin has been associated with harm. Thrombomodulin has shown promise in limited retrospective studies however further prospective data are needed. rFVIIa may have a role in cases of life-threatening bleeding however evidence is largely anecdotal. Additional studies evaluating the above interventions, and investigating other potential interventions are needed.
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Affiliation(s)
- Leonard Naymagon
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - John Mascarenhas
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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23
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Sabljić N, Mitrović M. Clinical utility of rotational thromboelastometry in detecting hemostatic disorders. MEDICINSKI PODMLADAK 2020. [DOI: 10.5937/mp71-27853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Hemostasis represents an equilibrium between procoagulant and anticoagulant processes, but once this balance is shifted to one side, it leads to coagulopathy presented by pathological bleeding or thrombosis. Many conditions could cause coagulopathy. The most common are sepsis, severe traumas and malignancies. Widely used conventional coagulation tests (CCTs), focused only on clot initiation, are primary used to detect hypocoagulability. Viscoelastographic tests (VET), like rotational thromboelastometry (ROTEM), can detect problems in different stages of coagulation, from initiation thought clot elongation and propagation, to the clot lysis and might reveal both, hypercoagulability and hypocoagulability. Rotational thromboelastometry have gained popularity in the care of patients with TIC, as a tool to guide transfusion support. Nowadays it is widely used in other medical specialties, as well. Several studies in septic patients pointed out hypocoagulable ROTEM pattern as a predictor of poor prognosis. Additionally, there is great interest of ROTEM usage in malignancies, although limited research is currently available. It suggests ROTEM have the ability to identify a patient in high risk of thrombosis. Further investigation trough randomized studies is needed to confirm ROTEM utility and to help in making a consensus about its use in different medical occasions.
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24
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Abstract
OBJECTIVE To describe the interdisciplinary management of acute leukemias across the continuum of care. DATA SOURCE Literature review and experiential knowledge. CONCLUSION Acute leukemia, including acute myelogenous leukemia, acute promyelocytic leukemia, and acute lymphoblastic leukemia, represent a heterogeneous group of hematologic malignancies with complex diagnostic requirements that drive risk-adapted treatment selection. Involvement of clinicians from a variety of specialties and disciplines is required to ensure safe and effective treatment, mitigate adverse events, and maintain or improve quality of life. Patient-centered communication, shared decision-making, and interdisciplinary communication are integral to patient outcomes. IMPLICATIONS FOR NURSING PRACTICE Oncology clinicians play a primary role in coordinating the interdisciplinary team and navigating the patient and caregiver experience across the acute leukemia continuum.
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Affiliation(s)
- Sandra Kurtin
- The University of Arizona Cancer Center, Tucson, AZ.
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25
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Syncope as Initial Presentation in an Undifferentiated Type Acute Myeloid Leukemia Patient with Acute Intracranial Hemorrhage. Brain Sci 2019; 9:brainsci9080207. [PMID: 31434194 PMCID: PMC6721397 DOI: 10.3390/brainsci9080207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/12/2019] [Accepted: 08/17/2019] [Indexed: 11/17/2022] Open
Abstract
Intracranial hemorrhage (ICH) is a catastrophic complication in patients with acute myeloid leukemia (AML). AML cells, especially in the acute promyelocytic leukemia subtype, may release microparticles (MPs), tissue factor (TF), and cancer procoagulant (CP) to promote coagulopathy. Hyperfibrinolysis is also triggered via release of annexin II, t-PA, u-PA, and u-PAR. Various inflammatory cytokines from cancer cells, such as IL-1β and TNF-α, activate endothelial cells and promote leukostasis. This condition may increase the ICH risk and lead to poor clinical outcomes. Here, we present a case under a unique situation with acute ICH detected prior to the diagnosis of AML. The patient initially presented with two episodes of syncope. Rapidly progressive ICH was noted in follow-up computed tomography (CT) scans. Therefore, we highlight that AML should be among the differential diagnoses of the etiologies of ICH. Early diagnosis and timely intervention are very important for AML patients.
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