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High incidence of disseminated intravascular coagulation during remission
induction of adult patients with acute lymphoblastic leukemia [see
comments]
AH Sarris, S Kempin, E Berman, J Michaeli, C Little, M Andreeff, T Gee, D Straus, B Gansbacher and D Filippa
Lymphoma-Leukemia Service, Memorial Hospital, New York, NY.
We determined the incidence and complications of disseminated intravascular
coagulation (DIC) at presentation and during remission induction of
previously untreated adults with acute lymphoblastic leukemia (ALL) or de
novo Philadelphia chromosome-positive ALL (PCALL) seen at Memorial Hospital
between January 1, 1978 and December 31, 1989. DIC was diagnosed in the
presence of (1) low fibrinogen (less than or equal to 160 mg/dL), (2)
prolonged prothrombin time (PT) and falling fibrinogen, or (3) prolonged PT
and positive fibrin split products (FSP). L-Asparaginase was not used
during remission induction. Among adequately screened patients with ALL,
DIC was detected in 7 of 58 (12%) before initiation of chemotherapy and in
35 of 45 (78%) during remission induction. DIC was not simply the result of
infection because clinical and laboratory signs of infection were absent in
16 patients, whereas only 2 of the 22 febrile patients with DIC had
positive cultures. Among the 38 patients with DIC at presentation or during
remission induction, serious complications were seen in 13 in temporal
association with DIC (pulmonary embolus in one, sagittal sinus thrombosis
in three, and serious hemorrhage in nine) and were major factors in the
deaths of three patients. Among the 10 patients with thorough screening but
no evidence of DIC there was only one hemorrhage during the same time
interval. In patients with PCALL, DIC was detected in 9% at presentation
and in 80% during remission induction. We conclude that DIC is rare at
presentation but common during remission induction of adult ALL and PCALL
and may be associated with significant thrombotic and hemorrhagic
complications. We suggest daily screening for DIC during the first 14 days
of remission induction. The treatment of DIC in ALL and PCALL should be a
subject of future clinical studies.
Volume 79,
Issue 5,
pp. 1305-1310,
03/01/1992
Copyright © 1992 by The American Society of Hematology
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