Retrospective Comparison of Recombinant Thrombomodulin and Conventional Drugs in a Treatment of DIC Caused by Acute Leukemia

Acute leukemia (AL) is often complicated with DIC, and its control is important for preventing severe adverse events. Here, we evaluated the efficacy of rTM compared to conventional drugs, such as Nafamostat, Gabexate and Dalteparin, in the treatment of DIC caused by AL. Between 2006 and 2011, 27 cases of AL were complicated with DIC. Eleven cases were APL and 16 were other leukemia. Among APL, 5 cases were treated with rTM and 6 were treated with conventional drugs. Patient characteristics were similar except the high level of FDP (149 vs 27.4 ng/ml, p=0.028), and D-dimer (DD) (102 vs 26.6ng/ml, p=0.032) in rTM group. To evaluate the efficacy of drugs, we investigated the number of days to reach less than 20ng/ml of FDP, or 10ng/ml of DD. Median days to reach the level (12 vs 11 days) and cumulative curve of achievement rate (HR 1.0, 95%CI 0.2–5.2) was similar. Considering the high level of FDP and DD in rTM group at the beginning of treatment, rTM might quickly improve DIC compared to conventional drugs. Next, we also evaluated the efficacy in AL other than APL. 8 out were treated with rTM and 8 were treated with conventional drugs. Patient characteristics were similar in each group. As for DIC improvement, median days of achievement was significantly short in rTM group (7 vs 13days, p=0.02). Cumulative rate also showed fast improvement of DIC in rTM group (HR 5.4, 95%CI 1.3–22.4) (figure). These results suggest that rTM could rapidly improve DIC complicated with AL compared to conventional drugs, and thus might have a benefit to prevent further severe complications. In addition high cost is a drawback of this drug, and hence appropriate use should be considered.