Introduction

Hemorrhagic early death (HED) remains a major cause of treatment failure among patients with acute promyelocytic leukemia (APL). We aimed to investigate the prognostic potential of rotational thromboelastometry (ROTEM) for bleeding in patients with APL.

Materials and Methods

31 newly-diagnosed APL patients (median age of 40 years; 14 female/17 male) that underwent treatment at the Clinic of Hematology UCCS from 2016-2020 with all-trans retinoic acid and anthracyclines were recruited. CBCs (complete blood count), conventional coagulation tests (CCTs), and ROTEM parameters obtained before treatment initiation were evaluated.

Results

All patients demonstrated at least one ROTEM parameter out of the reference range. ROTEM parameters associated with significant hemorrhage were EXTEM clotting time (CT) (P = 0.041) and INTEM amplitude 10 (A10) (P = 0.039), however, only EXTEM CT (P = 0.036) was associated with HED. Among CBCs and CCTs, only platelets were associated with significant bleeding (P = 0.015), while D-dimer was associated with both bleeding and HED (P = 0.001 and P = 0.002, respectively).

Conclusion

Our results indicate that ROTEM parameters may reveal hypocoagulability in APL patients and have the potential to improve current hemorrhage prognostic methods. Additionally, these results suggest the combination of ROTEM and CCTs might be useful in identifying patients at risk for HED.

中文翻译：

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旋转血栓弹力图在急性早幼粒细胞白血病患者中的应用

介绍

出血性早死（HED）仍然是急性早幼粒细胞白血病（APL）患者治疗失败的主要原因。我们旨在研究旋转血栓弹力图 (ROTEM) 对 APL 患者出血的预后潜力。

材料和方法

招募了 31 名新诊断的 APL 患者（中位年龄 40 岁；14 名女性/17 名男性），他们于 2016 年至 2020 年在血液学 UCCS 诊所接受了全反式维甲酸和蒽环类药物治疗。评估治疗开始前获得的 CBC（全血细胞计数）、常规凝血测试 (CCT) 和 ROTEM 参数。

结果

所有患者都表现出至少一项 ROTEM 参数超出参考范围。与显着出血相关的 ROTEM 参数是 EXTEM 凝血时间 (CT) (P = 0.041) 和 INTEM 振幅 10 (A10) (P = 0.039)，然而，只有 EXTEM CT (P = 0.036) 与 HED 相关。在 CBC 和 CCT 中，只有血小板与显着出血相关（P = 0.015），而 D-二聚体与出血和 HED 相关（分别为 P = 0.001 和 P = 0.002）。

结论

我们的结果表明 ROTEM 参数可能揭示 APL 患者的低凝状态，并有可能改善目前的出血预后方法。此外，这些结果表明 ROTEM 和 CCT 的组合可能有助于识别有 HED 风险的患者。