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Frequency and risk factors for thrombosis in acute myeloid leukemia and high-risk myelodysplastic syndromes treated with intensive chemotherapy: a two centers observational study

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Abstract

The frequency of thrombosis in AML has been evaluated only in a few studies and no validated predictive model is currently available. Recently, DIC score was shown to identify patients at higher thrombotic risk. We aimed to evaluate the frequency of thromboembolism in AML patients treated with intensive chemotherapy and to assess the ability of genetic and clinical factors to predict the thrombotic risk. We performed a retrospective observational study including 222 newly diagnosed adult AML (210) and high-risk MDS (12), treated with intensive chemotherapy between January 2013 and February 2020. With a median follow-up of 44 months, we observed 50 thrombotic events (90% were venous, VTE). The prevalence of thrombosis was 22.1% and the 6-months cumulative incidence of thrombosis was 10%. The median time to thrombosis was 84 days and 52% of the events occurred within 100 days from AML diagnosis. Khorana and DIC score failed to stratify patients according to their thrombotic risk. Only history of a thrombotic event (p = 0.043), particularly VTE (p = 0.0053), platelet count above 100 × 109/L at diagnosis (p = 0.036) and active smoking (p = 0.025) significantly and independently increased the risk of thrombosis, the latter particularly of arterial events. AML genetic profile did not affect thrombosis occurrence. Results were confirmed considering only thromboses occurring within day 100 from diagnosis. DIC score at diagnosis, but not thrombosis, was independently associated with reduced survival (p = 0.004). Previous VTE, platelet count above 100 × 109/L and active smoking were the only factors associate with increased thrombotic risk in AML patients treated intensively, but further studies are needed to validate these results.

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Authorship/ Conceptualization E. Beggiato, M. Cerrano, D. Ferrero; analysis and/or interpretation of data/ statistical analysis/ D. Di Cuonzo, M. Cerrano; data collection F. Martella, C. Secreto, M. Olivi, V. Apolito, I. Urbino; critical writing/writing—original draft preparation F. Martella, M. Cerrano; revising the intellectual content/ writing—review and editing All the authors; supervision E. Beggiato, D. Ferrero, M. Cerrano. All the authors have read and agreed to the final version of the manuscript.

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Correspondence to Marco Cerrano.

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Essentials

• AML is associated with an increased thrombotic risk but no validated predictive score is available.

• In a retrospective cohort of 222 intensively treated AML and MDS patients, thrombosis prevalence was 22.1%.

• DIC and Khorana score were not predive of thrombosis.

• Previous thrombosis, baseline platelets above 100 × 109/L and active smoking significantly increased the risk of thrombosis

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Martella, F., Cerrano, M., Di Cuonzo, D. et al. Frequency and risk factors for thrombosis in acute myeloid leukemia and high-risk myelodysplastic syndromes treated with intensive chemotherapy: a two centers observational study. Ann Hematol 101, 855–867 (2022). https://doi.org/10.1007/s00277-022-04770-6

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