Highlights
- •In newly diagnosed AML patients the catheter-related thrombosis (CRT) rate was >10%.
- •The study proposes simple models for CRT prediction in AML patients at diagnosis.
- •Acute promyelocytic leukemia (APL), prior VTE, high BMI and platelet counts are key risk factors.
- •Chronic obstructive pulmonary disease arose as a new CRT risk factor in non-APL AML.
- •CRT events are not associated with higher morality in newly diagnosed AML patients.
Abstract
Background
Catheter-related thrombosis (CRT) is a common complication in cancer patients, that
may lead to chemotherapy deferral, elevated risk for systemic infections and pulmonary
embolism. This study aimed to assess CRT incidence and risk factors in newly-diagnosed
acute myeloid leukemia (AML) patients and create predictive models potentially allowing
to decrease CRT occurrence in this population.
Methods
This retrospective single-center analysis included all AML patients treated at the
Rambam Health Care Campus between 2006 and 2019. Patient clinical and laboratory data
were collected to evaluate thrombosis occurrence and time from AML diagnosis to CRT
development. Multivariate classification models were created using logistic regression
(LR) and competing risk analyzes.
Results
The final analysis included 632 newly-diagnosed AML patients (mean age 54 ± 15 years).
CRT incidence was 10.1% [confidence interval (CI) 7.7–12.9%], median time from AML
diagnosis to CRT was 12.5 days [interquartile range 6–30]. In an LR multivariate model,
prior history of venous thromboembolism [adjusted odds ratio (AOR) 12.046, p < 0.0001], acute promyelocytic leukemia (APL) (AOR 2.824, p = 0.015), a high body mass index and initial platelet counts <100 × 10E9/L (AOR 1.059
and 0.546; p = 0.011 and 0.040, respectively) were significantly associated with high CRT risk.
Analysis of 587 non-APL patients demonstrated comparable results, with CRT incidence
of 9.3% (CI 7.0%-12.1%) and emergence of chronic obstructive pulmonary disease (COPD)
as a novel significant co-factor (AOR 34.491, p = 0.004). In both models, the area under curve (AUC) was ≥70%.
Conclusions
Significant CRT risk factors defined using the created model could be used for identification
of high-risk newly-diagnosed AML patients requiring CRT prophylaxis.
Keywords
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Article info
Publication history
Published online: May 05, 2022
Accepted:
April 28,
2022
Received in revised form:
April 25,
2022
Received:
March 21,
2022
Identification
Copyright
© 2022 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
