Early intracranial haemorrhages in acute promyelocytic leukaemia: analysis of neuroradiological and clinico-biological parameters

Br J Haematol. 2021 Apr;193(1):129-132. doi: 10.1111/bjh.17018. Epub 2020 Aug 10.

Abstract

Acute promyelocytic leukaemia (APL) represents a modern success of precision medicine. However, fatalities occurring within the first 30 days of induction treatment, in particular intracranial haemorrhage (ICH), remain the main causes of death. We studied the clinico-biological characteristics of 13 patients with APL who experienced ICH. Compared to 85 patients without this complication, patients with ICH were older and more frequently had high-risk APL. Moreover, positivity for the 'swirl' sign at neuroradiological imaging and hydrocephalus were predictors of a fatal outcome, together with lower fibrinogen, prolonged international normalized ratio (INR) and higher lactate dehydrogenase levels.

Keywords: acute promyelocytic leukaemia; early death; intracranial haemorrhage.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Child
  • Female
  • Fibrinogen / analysis
  • Humans
  • Hydrocephalus / diagnosis
  • Hydrocephalus / epidemiology
  • International Normalized Ratio / methods
  • Intracranial Hemorrhages / diagnosis
  • Intracranial Hemorrhages / etiology*
  • Intracranial Hemorrhages / mortality
  • L-Lactate Dehydrogenase / blood
  • Leukemia, Promyelocytic, Acute / blood*
  • Leukemia, Promyelocytic, Acute / complications*
  • Leukemia, Promyelocytic, Acute / diagnosis
  • Leukemia, Promyelocytic, Acute / drug therapy
  • Male
  • Middle Aged
  • Mortality
  • Neuroradiography / methods*
  • Neuroradiography / statistics & numerical data
  • Precision Medicine / statistics & numerical data
  • Predictive Value of Tests
  • Remission Induction / methods
  • Risk Factors
  • Tomography, X-Ray Computed / methods
  • Young Adult

Substances

  • Fibrinogen
  • L-Lactate Dehydrogenase