Disseminated intravascular coagulopathy in non-promyelocytic acute myeloid leukemia: Incidence, clinical and laboratory features and prognostic significance

Abstract

Introduction: Acute promyelocytic leukemia (APL) has the highest risk for overt disseminated intravascular coagulopathy (DIC), with reported incidence of DIC of up to 90%, as compared to 10-40% in other AML types. The influence of DIC on early death in non-APL AML patients has not been evaluated so far. Aim: The aim of our study was to analyze the incidence of DIC, its clinical and laboratory characteristics, and the impact on the survival and early death of patients with non-APL AML. Materials and methods: A total of 176 patients with non-APL AML, diagnosed and treated at the Clinic for Hematology of the Clinical Center of Serbia, between 2015 and 2020, were evaluated retrospectively. The diagnosis of DIC was made on the basis of ISTH (International Society on Thrombosis and Haemostasias) criteria. Results: The mean age of our patients was 53.8 ± 14.6 years, with 99/176 patients being men (56.2%). DIC was present in 74/176 patients (42.05%), who had a significant prevalence of the hemorrhagic syndrome (p = 0.01). The risk factors for overt DIC were the following: older age (p <0.01), comorbidities (p = 0.01), leukocytosis (p <0.001) and a high level of LDH (p <0.001). The FAB (French, American and British) type of non-APL AML, the cytogenetic risk group, and CD56 (cluster of differentiation) had no influence on overt DIC (p > 0.05). No difference was found in early mortality, outcome, and the survival of non-APL AML patients, with and without DIC (p > 0.05). Conclusion: Older age at diagnosis, comorbidities, leukocytosis, and high LDH concentrations are found to be adverse risk factors for overt DIC in non-APL AML patients. If treated promptly, with immediate, adequate and intensive use of blood derivates and components, DIC has no negative impact on early mortality, outcome, and survival.