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Altered Fibrinolysis in Hematological Malignances
Søren Thorgaard Bønløkke1,2, Hans Beier Ommen2,3, Anne-Mette Hvas1,3
1Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.
Seminars in Thrombosis and Hemostasis
|May 31, 2021
Summary
Altered fibrinolysis is linked to bleeding and thrombosis in blood cancers. This review found limited, old data, suggesting hypofibrinolysis in myeloproliferative neoplasms and hyperfibrinolysis in AL-amyloidosis.
Area of Science:
- Hematology
- Oncology
- Biochemistry
Background:
- Bleeding and thrombosis are significant complications of hematological malignancies.
- Fibrinolysis plays a crucial role in regulating hemostasis and impacts these complications.
- Understanding altered fibrinolysis in blood cancers is vital for patient management.
Purpose of the Study:
- To systematically review and discuss the current literature on clinical manifestations, diagnosis, and treatment of altered fibrinolysis in hematological malignancies.
- To provide an overview of fibrinolysis in various blood cancers, excluding acute promyelocytic leukemia and disseminated intravascular coagulation.
Main Methods:
- A systematic literature search was conducted using PubMed, Embase, and Web of Science.
- Original studies investigating fibrinolysis in hematological malignancies were included.
- Studies on acute promyelocytic leukemia or disseminated intravascular coagulation were excluded.
Main Results:
- 32 studies were identified, with most published over two decades ago.
- Limited studies examined comprehensive fibrinolysis markers or used dynamic clot lysis assays.
- L-asparaginase treatment in acute leukemia induced hypofibrinolysis; results during chemotherapy were ambiguous.
- Hypofibrinolysis was noted in multiple myeloma and myeloproliferative neoplasms.
- Hyperfibrinolysis was observed in amyloid light chain-amyloidosis; no alterations were found in lymphoma.
Conclusions:
- Sparse and outdated evidence exists on fibrinolysis in hematological malignancies.
- A trend towards hypofibrinolysis in myeloproliferative neoplasms and hyperfibrinolysis in AL-amyloidosis was observed.
- L-asparaginase treatment induces hypofibrinolysis in acute leukemias, while other findings remain inconclusive.
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