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Prevalence and risk factors of disseminated intravascular coagulation in childhood acute lymphoblastic leukemia
Natsaruth Songthawee1, Shevachut Chavananon1, Pornpun Sripornsawan1
1Division of Hematology and Oncology, Department of Pediatrics, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Insights
Disseminated intravascular coagulation (DIC) affects 15.4% of childhood acute lymphoblastic leukemia (ALL) patients at diagnosis and 24.4% during chemotherapy. DIC significantly lowers survival rates in pediatric ALL.
Area of Science:
- Pediatric Hematology Oncology
- Hematologic Malignancies
- Coagulation Disorders
Background:
- Limited research exists on disseminated intravascular coagulation (DIC) in childhood acute lymphoblastic leukemia (ALL).
- Understanding DIC prevalence, risk factors, and outcomes is crucial for managing pediatric ALL.
- This study addresses the gap in knowledge regarding DIC in pediatric ALL patients.
Purpose of the Study:
- To determine the prevalence of DIC at presentation and during induction chemotherapy in pediatric ALL.
- To identify risk factors associated with DIC in this patient population.
- To evaluate the impact of DIC on survival outcomes in childhood ALL.
Main Methods:
- Retrospective review of medical records for ALL patients under 15 years old.
- Logistic regression analysis to identify risk factors for DIC.
- Kaplan-Meier method to analyze survival rates.
Main Results:
- DIC was present in 15.4% of patients at ALL presentation and 24.4% during induction chemotherapy.
- Risk factors for DIC at presentation included prior antibiotic use, high white blood cell count, low platelets, and high NCI risk.
- Risk factors during induction chemotherapy included prior antibiotic use, high peripheral blasts, and transaminitis.
Conclusions:
- Antibiotic use prior to admission, hyperleukocytosis, thrombocytopenia, and high NCI risk are key predictors of DIC at ALL presentation.
- Antibiotic use, high peripheral blasts, and transaminitis are associated with DIC during induction chemotherapy.
- DIC is linked to significantly poorer survival rates in pediatric ALL patients, necessitating close monitoring and early intervention.
Background:
Few studies have examined disseminated intravascular coagulation (DIC) in childhood acute lymphoblastic leukemia (ALL). Our aims were to evaluate the prevalence, risk factors and outcomes of DIC at ALL presentation and during induction chemotherapy.
Methods:
The medical records of ALL patients aged <15 years were retrospectively reviewed. Logistic regression analysis was used to identify risk factors. The Kaplan-Meier method was used to depict survival.
Results:
Of the 312 patients, 48 (15.4%) and 76 (24.4%) had DIC at presentation and during induction chemotherapy, respectively. Risk factors for DIC at presentation (OR and 95% CI) were antibiotics prior to admission 2.34 (1.17-4.89), white blood cell count ≥100 × 109/L 2.39 (1.04-5.72), platelets <100 × 109/L 5.44 (1.84-23.4) and high National Cancer Institute (NCI) risk 2.68 (1.08-6.62). Risk factors for DIC during induction chemotherapy were antibiotics prior to admission 1.86 (1.07-3.27), high peripheral blasts 1.01 (1.00-1.02) and transaminitis 2.02 (1.18-3.48). Five-year overall survival of patients who had DIC was significantly lower than those who did not (45.0% vs. 74.1%, p <0.001).
Conclusion:
Antibiotics prior to admission, hyperleukocytosis, thrombocytopenia and high NCI risk were risk factors of DIC at presentation. Antibiotics prior to admission, high peripheral blasts and transaminitis were risk factors of DIC during induction chemotherapy.
Impact:
There are only two studies, both published before 2000, evaluating risk factors of DIC in pediatric ALL patients without reporting outcomes. DIC was associated with lower remission and survival rates in pediatric ALL patients. We identified the risk factors of DIC at presentation as antibiotics prior to admission, hyperleukocytosis, thrombocytopenia and high NCI risk. The risk factors of DIC during induction chemotherapy were antibiotics prior to admission, high peripheral blasts and aspartate transaminitis. Pediatric ALL patients who have the aforementioned risk factors should be closely monitored for DIC secondary to infection, and early treatment with appropriate antimicrobial agents is recommended.
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