[Risk factors and prognosis of disseminated intravascular coagulation in patients with non-M(3) acute myeloid...

This study retrospectively analyzed 407 newly diagnosed patients with non-M(3) acute myeloid leukemia (AML) treated at the First Affiliated Hospital of Soochow University between 2016 and 2024. Based on the ISTH-2018 DIC score, patients were classified into a DIC group (n=109) and a non-DIC group (n=298), and their clinical characteristics and survival were compared. The results showed that white blood cell count, bone marrow blast percentage, alanine aminotransferase, aspartate aminotransferase, and lactate dehydrogenase levels were significantly higher in the DIC group than in the non-DIC group (all P<0.001). Molecular analysis indicated that NPM1, FLT3-ITD, and SETD2 mutations were significantly enriched in the DIC group (all P<0.05). Multivariable logistic regression showed that a high white blood cell count, a high blast percentage, an elevated lactate dehydrogenase level, and NPM1 mutation were independent risk factors for DIC (all P<0.05). Clinical outcome analysis showed that the DIC group had a higher incidence of early severe bleeding (P<0.001) and a lower complete remission rate after first induction chemotherapy (P<0.05). In the overall population, especially in the European LeukemiaNet (ELN) 2022 high-risk subgroup, overall survival (OS) was significantly worse in the DIC group than in the non-DIC group (P<0.05). Multivariable Cox regression further confirmed that concomitant DIC, early severe bleeding, and older age were independent risk factors for OS in patients with non-M(3) AML (all P<0.05). These findings suggest that DIC in non-M(3) AML is closely associated with a high tumor burden and specific molecular abnormalities and is accompanied by a higher risk of early bleeding and poorer survival outcomes. DIC may therefore represent a higher-risk clinical feature requiring enhanced early monitoring and risk-stratified management.