Prediction of fatal intracranial hemorrhage in patients with acute myeloid leukemia
Journal
Annals of Oncology
Journal Volume
20
Journal Issue
6
Pages
1100-1104
Date Issued
2009
Author(s)
Abstract
Background: Intracranial hemorrhage (ICH) is the second leading cause of mortality in patients with acute myeloid leukemia (AML). However, the prognostic factors for ICH in AML patients are still under investigation. Patients and methods: A total of 841 AML patients admitted to the Department of Internal Medicine from January 1995 to December 2007 were enrolled in this study. Results: There were 51 patients with ICH, median age of 51 (range 17-86), including 12 patients diagnosed as acute promyelocytic leukemia. Forty-three patients were refractory/relapsed status. ICH was localized in the supratentorium (44 cases), basal ganglion (9), cerebellum (5), and brainstem (4). Twenty-one patients had multiple sites. Thirty-eight patients had intraparenchymal hemorrhage, 16 subarachnoid hemorrhage (SAH), 10 subdural hemorrhage, and one epidural hemorrhage (EDH). Hemorrhage ruptured into the ventricles in 13 patients. Thirty-four patients (67%) died of ICH within 30 days of diagnosis. Multivariate analysis revealed four independent prognostic factors, prolonged prothrombin time international normalized ratio >1.5 (P < 0.001), brainstem hemorrhage (P = 0.001), SAH (P = 0.017), and EDH (P = 0.014). Other clinico-laboratory data had no impact on 30-day survival. Conclusions: ICH has high morbidity and mortality in AML. Early detection and aggressive correction coagulopathy may prevent the catastrophic event. Prompt image study for locations and types of ICH can predict outcomes. ? The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.
SDGs
Other Subjects
anthracycline derivative; cytarabine; retinoic acid; acute granulocytic leukemia; adolescent; adult; aged; article; basal ganglion hemorrhage; brain hemorrhage; brain stem bleeding; cancer localization; cancer mortality; cancer relapse; cerebellum hemorrhage; craniotomy; disease association; drug megadose; epidural hemorrhage; female; hematopoietic stem cell transplantation; human; international normalized ratio; intraparenchymal hemorrhage; major clinical study; male; morbidity; prediction; priority journal; prognosis; promyelocytic leukemia; prothrombin time; refractory period; subarachnoid hemorrhage; subdural hematoma; supratentorium hemorrhage
Type
journal article