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Thrombosis in Acute Myeloid Leukemia: Pathogenesis, Risk Factors and Therapeutic Challenges

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Opinion statement

Prophylaxis and treatment of thrombosis in leukemic patients still represent a major challenge with several clinical questions yet to be solved. Indeed, the paucity of evidence makes the management of venous thromboembolic events difficult and not uniform. Due to thrombocytopenia, patients with acute myeloid leukemia (AML) are underrepresented in trials investigating prophylaxis and treatment of thrombosis in cancer, and prospective data are lacking. Likewise, the therapeutic approach with anti-coagulants in leukemic patients is inferred from guidelines originally developed in the solid cancer setting and clear recommendations in the thrombocytopenic population are limited. Importantly, the discrimination of patients at high risk of bleeding from those with a predominant risk of thrombosis remains extremely difficult with no predictive score validated so far. Thus, the management of thrombosis often relies on clinician experience, and it is tailored to the individual patient, constantly balancing thrombotic and hemorrhagic risks. Who would benefit from primary prophylaxis and how a thrombotic event should be appropriately treated are some of the unanswered questions that the future guidelines and trials should address. Moreover, a greater effort should be made to identify robust predictive factors able to guide clinicians in the management of this potential serious complication for AML patients.

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Authors and Affiliations

  1. Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Turin, Italy

    Matteo Olivi MD, Federica Di Biase MD, Giuseppe Lanzarone MD, Giulia Arrigo MD, Federica Martella MD, Vincenzo Apolito MD, Benedetto Bruno MD, PhD, Dario Ferrero MD & Eloise Beggiato MD

  2. Department of Oncology, Division of Hematology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88/90, 10126, Turin, Italy

    Giulia Arrigo MD, Carolina Secreto MD, Roberto Freilone MD, Ernesta Audisio MD & Marco Cerrano MD

  3. Department of Hematology and Bone Marrow Transplant, Hospital Card. G. Panico, Tricase, LE, Italy

    Federica Martella MD

  4. Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, Regina Margherita Children’s Hospital, Turin, Italy

    Vincenzo Apolito MD

Authors
  1. Matteo Olivi MD
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  2. Federica Di Biase MD
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  3. Giuseppe Lanzarone MD
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  4. Giulia Arrigo MD
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  5. Federica Martella MD
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  6. Vincenzo Apolito MD
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  7. Carolina Secreto MD
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  8. Roberto Freilone MD
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  9. Benedetto Bruno MD, PhD
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  10. Ernesta Audisio MD
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  11. Dario Ferrero MD
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  12. Eloise Beggiato MD
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  13. Marco Cerrano MD
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Corresponding author

Correspondence to Marco Cerrano MD.

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Olivi, M., Di Biase, F., Lanzarone, G. et al. Thrombosis in Acute Myeloid Leukemia: Pathogenesis, Risk Factors and Therapeutic Challenges. Curr. Treat. Options in Oncol. 24, 693–710 (2023). https://doi.org/10.1007/s11864-023-01089-w

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