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

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Abstract

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.

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Data availability

The dataset generated during and analyzed in the study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank the clinical data managers of the Chaim Sheba hematology division for their contribution to this project.

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Author notes

  1. Tamer Hellou and Omri Cohen share equal contribution.

Authors and Affiliations

  1. Hematology Division, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, 52621, Tel-Hashomer, Israel

    Tamer Hellou, Abraham Avigdor, Irina Amitai, Avichai Shimoni & Jonathan Canaani

  2. Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Tamer Hellou, Omri Cohen, Abraham Avigdor, Irina Amitai, Avichai Shimoni, Mudi Misgav & Jonathan Canaani

  3. National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel-Hashomer, Israel

    Omri Cohen & Mudi Misgav

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  1. Tamer Hellou
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Contributions

JC designed the research and analyzed the data. JC and OC wrote the manuscript. TH, AS, AA, IA, and MS provided clinical data and commented on manuscript. All authors read and approved the final manuscript.

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Correspondence to Jonathan Canaani.

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Research involving human participants

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of the Sheba Medical Center approved this study.

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Owing to the retrospective and anonymized nature of this retrospective chart review study, a waiver was granted by the Sheba Medical Center Institutional Review Board.

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Hellou, T., Cohen, O., Avigdor, A. et al. The occurrence of thrombosis during intensive chemotherapy treatment for acute myeloid leukemia patients does not impact on long-term survival. Ann Hematol 102, 1037–1043 (2023). https://doi.org/10.1007/s00277-023-05158-w

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  • DOI: https://doi.org/10.1007/s00277-023-05158-w

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