A scoring system to predict life-threatening thromboischemic events in patients with acute promyelocytic leukemia: the PETHEMA/PALG study
Year: 2025
Type: article
Study design: Observational Study
Abstract: Acute promyelocytic leukemia (APL) is a highly curable leukemia characterized by life-threatening coagulopathy leading to hemorrhagic and thrombo-ischemic events. We analyzed the incidence, outcomes and risk factors of thrombo-ischemic events in a large series of 1,210 patients with newly diagnosed APL reported to the PETHEMA registry. Therapy consisted of ATRA and chemotherapy (AIDA-based). Median age of patients was 46 years (range 2-90 years). Fifty-eight patients (5%) did not start the AIDA regimen either because they were unfit for chemotherapy, or because of early death before initiating ATRA. A total of 195 (16%) patients developed thrombo-ischemic events, the most frequent being superficial-vein and/or central catheter-related (6.9%) followed by central nervous system (2.2%), deep-vein thrombosis (2.1%), pulmonary embolism (2.1%), acute myocardial infarction (1.6%), or other locations (1.2%). Thrombo-ischemic events mostly occurred at diagnosis and during induction (4.0% and 9.3%, respectively). Patients developing life-threatening thrombo-ischemic events (i.e., excluding superficial and/or catheter-related) at diagnosis / induction had a 31% early death rate. Prolonged activated partial thromboplastin time (aPTT), age >40 years, ECOG performance status >1, platelets >25x109/L, and absence of bleeding at presentation were independent risk factors for life-threatening thrombo-ischemic events. Using these variables (1 point each), we developed and validated the Thromb-On risk score, identifying a high-risk group (3-5 points). The Thromb-On risk score was validated in a cohort of 585 patients treated since 2017 with arsenic trioxide plus all-trans retinoic acid (ATRA) (<10x109 leukocytes) or according to the AIDA protocol (≥10x109 leukocytes). This study could help to improve prevention and management of life-threatening thrombo-ischemic events through risk-adapted guidance, potentially leading to a decrease in early mortality in APL.
Source: Haematologica
Authors: Rebeca Rodríguez-Veiga, Cristina Gil, Marta Sobas, Laura Torres-Miñana, Carmen Botella, Javier De la Serna, Teresa Bernal, Olga Salamero, Cristina Otero, Irene Navarro-Vicente, Carlos De Miguel, Ana Garrido, Susana Vives, Juan Bergua, Manuel Pérez-Encinas, Lorenzo Algarra, José González-Campos, Maria del Mar Caballero Gómez, Maria Virginia Prates, Celina Benavente, Mar Tormo, Marta Cervera, Patricia Fazio, Maria Elena Amutio, Raimundo García, Helena Pomares, Belén Vidriales, Josefina Serrano, Mª Luz Amigo, Vicente Rubio, Ágata Almela, Manuel Barrios, Claudia Lucia Sossa-Melo, Monika Paluszewska, Andrés Novo, Tomasz Gromek, Gabriela Rodríguez-Macías, Jolanta Oleksiuk, Pilar Lloret-Madrid, Pau Montesinos
Institutions: Hospital Universitari i Politècnic La Fe, Instituto de Investigación Sanitaria La Fe, Hospital General Universitario de Alicante Doctor Balmis, University of Wrocław, Wroclaw Medical University, Universidad Complutense de Madrid, Hospital Universitario 12 De Octubre, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institute of Oncology, Hospital Maciel, Hospital Universitario Puerta de Hierro Majadahonda, Hospital de Sant Pau, Josep Carreras Leukaemia Research Institute, Hospital Universitari Germans Trias i Pujol, Hospital San Pedro de Alcántara, Complejo Hospitalario Universitario de Santiago, Hospital General Universitario de Albacete, Complejo Hospitalario Universitario de Albacete, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Centro de Investigación Biomédica en Red de Cáncer, Universidad de Sevilla, Hospital Universitario Insular de Gran Canaria, Hospital Italiano La Plata, Hospital Clínico San Carlos, Hospital Clínico Universitario de Valencia, Hospital Universitari Joan XXIII de Tarragona, Hospital de Cruces, Institut Català d'Oncologia, Universidad de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Universitario Reina Sofía, University of Córdoba, Hospital General Universitario Morales Meseguer, Hospital Universitario de León, Hospital Regional Universitario de Málaga, Universidad Autónoma de Bucaramanga, Medical University of Warsaw, Hospital Universitario Son Espases, Medical University of Lublin, Hospital General Universitario Gregorio Marañón, Medical University of Białystok
Language: English
Subfield: Molecular Biology
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $2,157
OpenAlex ID: W4416167111