Coagulation Profile As Prognostic Indicator in Acute Myeloid Leukemia,

Evidence of deranged coagulation is encountered at presentation in a subset of patients with non-promyelocytic acute myelogenous leukemia (AML). High fibrinogen level at presentation is reported to be predictive of failure to achieve complete remission and of early death in AML (Lancet. 2010 Dec 11;376(9757):2000–8). Broader correlation of abnormal coagulation parameters with additional clinical outcomes in AML is needed.

To determine association of coagulation parameters with overall survival (OS), event-free survival (EFS), complete response (CR) as well as CR duration (CRD).

We performed a retrospective analysis of prospectively collected data from 869 consecutive patients with acute myeloid leukemia (AML) treated at MD Anderson Cancer Center between the years 2005–2009. Patients with acute promyelocytic leukemia (APL) were excluded. Coagulation parameters were recorded at the time of diagnosis and included prothrombin time (PT), international normalized ratio (INR), activated thromboplastin time (aPTT), fibrinogen level and D-Dimer. Chi-square test, Wilcoxon rank sum test, as well as logistic regression analysis were applied to determine the association of CR with coagulation parameters. The Kaplan-Meier method was used to estimate the probability of survival outcomes and Cox proportional hazards models were fit to determine the association of time to event outcomes (CRD, OS and EFS) with coagulation parameters.

Univariate logistic regression analysis showed that patients with higher fibrinogen levels had lower CR rates (p=0.02), shorter CRD (p=0.05) and OS (p=0.04). Event free survival was defined as time from presentation to loss of response, failure to respond and death due to any cause. By multivariate logistic regression, high fibrinogen was also associated with shorter EFS (p value = 0.03). PT, aPTT, D-Dimer as continuous variables were not significantly associated with clinical outcomes.

High fibrinogen level at presentation is associated with poor outcome in patients with acute myeloid leukemia. The potential biological role of high fibrinogen level in resistance to chemotherapy or the possibility of fibrinogen levels being a surrogate marker of heightened inflammatory state needs to be explored.

No relevant conflicts of interest to declare.