The occurrence of thrombosis during intensive chemotherapy treatment for acute myeloid leukemia patients does not impact on long-term survival

Venous thromboembolism (VTE) is frequently seen in acute myeloid leukemia (AML) patients and presents a significant clinical challenge. The association of VTE during intensive chemotherapy with risk models such as the Medical Research Council (MRC) cytogenetic-based assessment and the European LeukemiaNet (ELN) 2017 molecular risk model have not been rigorously evaluated. Additionally, there is a paucity of data pertaining to the long-term prognostic impact of VTE in AML patients. We performed an analysis of baseline parameters of AML patients diagnosed with VTE during intensive chemotherapy and compared them with patients without VTE. The analyzed cohort consisted of 335 newly diagnosed AML patients with a median age of 55 years. Thirty-five patients (11%) were classified as MRC favorable risk, 219 (66%) patients as intermediate risk, 58 patients (17%) as adverse risk. Per ELN 2017, 132 patients (40%) had favorable risk disease, 122 patients (36%) intermediate risk, and 80 patients (24%) had adverse risk. VTE was seen in 33 patients (9.9%), occurring mostly during induction (70%), and required catheter removal in 9 patients (28%). Baseline clinical, laboratory, molecular, and ELN 2017 parameters were not significantly different groups. However, MRC intermediate-risk group patients were significantly more likely to experience thrombosis compared to favorable risk and adverse risk patients (12.8% versus 5.7% and 1.7%, respectively; p = 0.049). Median overall survival was not significantly impacted by the diagnosis of thrombosis (3.7 years versus 2.2 years; p = 0.47). VTE is tightly associated with temporal and cytogenetic parameters in AML but does not significantly impact on long-term outcomes.

[1]  B. Brenner,et al.  A prediction model for central venous catheter-related thrombosis in patients with newly-diagnosed acute myeloid leukemia: A derivation cohort analysis. , 2022, European journal of internal medicine.

[2]  A. Busca,et al.  Frequency and risk factors for thrombosis in acute myeloid leukemia and high-risk myelodysplastic syndromes treated with intensive chemotherapy: a two centers observational study , 2022, Annals of Hematology.

[3]  S. Fujiwara,et al.  Risk Factors for Complications Associated with Peripherally Inserted Central Catheters During Induction Chemotherapy for Acute Myeloid Leukemia , 2021, Internal medicine.

[4]  M. Konopleva,et al.  Venetoclax Combined With FLAG-IDA Induction and Consolidation in Newly Diagnosed and Relapsed or Refractory Acute Myeloid Leukemia , 2021, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[5]  M. Levis,et al.  A Phase 1 Study of Gilteritinib in Combination with Induction and Consolidation Chemotherapy in Patients with Newly Diagnosed AML: Final Results , 2020 .

[6]  H. Döhner,et al.  Ivosidenib or enasidenib combined with intensive chemotherapy in patients with newly diagnosed AML: a phase 1 study. , 2020, Blood.

[7]  Emily A. Stevens,et al.  AML risk stratification models utilizing ELN-2017 guidelines and additional prognostic factors: a SWOG report , 2020, Biomarker Research.

[8]  F. Pane,et al.  A Frontline Approach With Peripherally Inserted Versus Centrally Inserted Central Venous Catheters for Remission Induction Chemotherapy Phase of Acute Myeloid Leukemia: A Randomized Comparison , 2019, Clinical lymphoma, myeloma & leukemia.

[9]  I. Flinn,et al.  Molecular remission and response patterns in patients with mutant-IDH2 acute myeloid leukemia treated with enasidenib. , 2019, Blood.

[10]  H. Schünemann,et al.  American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism. , 2018, Blood advances.

[11]  P. Poredos,et al.  Endothelial Dysfunction and Venous Thrombosis , 2018, Angiology.

[12]  B. Medeiros Interpretation of clinical endpoints in trials of acute myeloid leukemia. , 2018, Leukemia research.

[13]  A. Venditti,et al.  Thrombosis in adult patients with acute leukemia , 2017, Current opinion in oncology.

[14]  Bob Löwenberg,et al.  Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. , 2017, Blood.

[15]  P. Sonneveld,et al.  Disseminated intravascular coagulation at diagnosis is a strong predictor for thrombosis in acute myeloid leukemia. , 2016, Blood.

[16]  J. Brandwein,et al.  Incidence of catheter-related thrombosis in acute leukemia patients: a comparative, retrospective study of the safety of peripherally inserted vs. centrally inserted central venous catheters , 2016, Annals of Hematology.

[17]  H. Kantarjian,et al.  A retrospective study of venous thromboembolism in acute leukemia patients treated at the University of Texas MD Anderson Cancer Center , 2014, Cancer medicine.

[18]  Inho Kim,et al.  Implications of cytogenetics for venous thromboembolism in acute myeloid leukaemia , 2014, Thrombosis and Haemostasis.

[19]  A. Venditti,et al.  Infections increase the risk of central venous catheter-related thrombosis in adult acute myeloid leukemia. , 2013, Thrombosis research.

[20]  R. Hills,et al.  Refinement of cytogenetic classification in acute myeloid leukemia: determination of prognostic significance of rare recurring chromosomal abnormalities among 5876 younger adult patients treated in the United Kingdom Medical Research Council trials. , 2010, Blood.

[21]  H. Chew,et al.  Venous thromboembolism in patients with acute leukemia: incidence, risk factors, and effect on survival. , 2009, Blood.

[22]  P. Chiusolo,et al.  The risk of thrombosis in patients with acute leukemia: occurrence of thrombosis at diagnosis and during treatment , 2005, Journal of thrombosis and haemostasis : JTH.