Clinical Research on Hematological Malignancies Complicated with dic-a Single Center Report in China

Objective This study aimed to explore the most appropriate way of diagnosis and treatment among the patients with hematological malignancies complicated with disseminated intravascular coagulation (DIC) by evaluating the risk factors which would affect the prognosis and the efficiency of therapies.

Methods The data of 162 definitely-diagnosed patients in West China Hospital between 2009 and 2013 has been collected and analyzed in our retrospective study. We have summarized the information on clinical features, laboratory indicators and interventions, which has been statistically analyzed to evaluate the effect on mortality.

Results Elderly patients, AML patients accompanied with hyperleukocytosis, APL patients accompanied with differentiation syndrome combined deteriorated DIC symptoms, patients accompanied with infections, refractory/relapsed patients, patients with any of the following clinical symptoms such as gastrointestinal bleeding, intracranial hemorrhage, more than three sites of bleeding, acute renal dysfunction,acute respiratory dysfunction, acute left heart failure, MOF or shock, presented higher mortality (P<0.05).We found that there was difference in terms of mortality when we defined the cut-off value of PLT as 10×10⁹/L (P<0.05). According to the ISTH criteria or Chinese guideline, the patients with abnormal PTAAPTTA AT-III, or ISTH score>6 had poorer prognosis. In our study, we tried to classify Fig < 1 g/L or > 4 g/L as a Fig abnormal group, the rest of the patients classified as a Fig normal group, then we found the abnormal Fig group had an increased mortality (P < 0.05). In addition, it had been found that patients who received standard chemotherapy had lower mortality (P < 0.05). With respect to non-APL patients, ones who took anti-fibrinolysis agents had similar mortality compared with the patients who didn't (P>0.05).

Conclusions Among the patients of hematological malignancies complicated with DIC, the patients with any of above clinical risk factors or abnormal laboratory indicators would have poorer prognosis. Moreover, the cut-off value of PLT should be dropped when we diagnose or evaluate this kind of patients’ prognosis. We put forward a new cut-off value of Fig as described above and it is valuable to evaluate the prognosis. The treatment of underlying diseases and substitute therapy act as basis of these patients, however, the adverse effects should be pay attention to as well as infections and acute heart failure. No benefit has been shown in the non-APL patients treated with anti-fibrinolytic agents.