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    Poster Networking

    Venous Thromboembolism

    Poster Networking Session

    PB0955 - Factors associated with thrombo-hemorrhagic deaths in patients with Acute Promyelocytic Leukemia treated with Arsenic Trioxide and All-Trans Retinoic Acid

    Monday, June 26, 2023
    18:30 – 19:30 ET
    Room: Exhibition

      Co-Author(s)

    • CS

      Charanpreet Singh

      Senior Research Associate
      Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
      Chandigarh, Chandigarh, India

    • UY

      Uday Yanamandra

      Consultant
      Armed Forces Medical College,Pune, India
      Chandigarh, Chandigarh, India

    • PK

      Parathan Karunakaran

      Consultant
      Department of Medical Oncology, Cancer Institute (WIA),Chennai, India
      Chandigarh, Chandigarh, India

    • NJ

      Nishant Jindal

      Consultant
      BMT Unit, Department of Medical Oncology, ACTREC- Tata Memorial Centre, Navi Mumbai, India
      Chandigarh, Chandigarh, India

    • SK

      Saloni Kumar

      Undergraduate Student
      Government Medical College and Hospital, Chandigarh, India
      Chandigarh, Chandigarh, India

    • NS

      Neha Saini

      Nursing Officer
      Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
      Chandigarh, Chandigarh, India

    • AJ

      Aditya Jandial

      Senior Research Associate
      Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
      Chandigarh, Chandigarh, India

    • AJ

      Arihant Jain

      Associate Professor
      Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
      Chandigarh, Chandigarh, India

    • DL

      Deepesh Lad

      Associate Professor
      Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
      Chandigarh, Chandigarh, India

    • GP

      Gaurav Prakash

      Professor
      Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
      Chandigarh, Chandigarh, India

    • AK

      Alka Khadwal

      Professor
      Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
      Chandigarh, Chandigarh, India

    • SN

      Shano Naseem

      Professor
      Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
      Chandigarh, Chandigarh, India

    • NK

      Narender Kumar, Doctor of Philosophy

      Postdoctoral Fellow
      LSUHSC
      New Orleans, Louisiana, United States

    • Jasmina Ahluwalia, MD (she/her/hers)

      Professor
      Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
      Chandigarh, Chandigarh, India

    • NV

      Neelam Varma

      Professor
      Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
      Chandigarh, Chandigarh, India

    • SV

      Subhash Varma

      Professor
      Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
      Chandigarh, Chandigarh, India

      • Presenting Author(s)

    • Pankaj Malhotra, MD

      Professor
      Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
      Chandigarh, Chandigarh, India

    Background: Acute Promyelocytic Leukemia (APL) is associated with excellent long-term outcomes. However, early mortality, mainly due to coagulopathy, remains a challenge.

    Aims: To study the risk factors associated with early thrombo-hemorrhagic deaths.

    Methods: All patients diagnosed with APL (Bone marrow and PML RAR alpha positive) were analyzed between January 2006-June, 2022 at our center. The induction and consolidation therapy was with Arsenic Trioxide and All-trans Retinoic Acid without chemotherapy (except hydroxyurea). Complete blood counts, coagulogram and biochemical parameters at diagnosis and during induction therapy were noted. A major bleed was defined as per the ISTH definition. Early death (ED) was defined as death occurring within 7 days of induction therapy.

    Results: The median age of 248 patients (140 males, 108 females) was 32 years (Range- 12-73). Two hundred (80.6%) patients had bleeding at presentation. The most common site of bleeding was epistaxis/gum bleed (N=128; 51.6%)(Figure 1). A major bleed was seen in 31 patients (12.5%), including 22 patients with an Intra-cranial bleed. Eight patients (3.2%) had thrombosis at presentation, including 3 patients each with cerebral-venous and cerebral-arterial thrombosis. Eighteen patients had a new major bleed and 4 patients had new onset thrombosis during induction. Thirty-two patients (12.9%) had ED, of which 19 were secondary to bleeding or thrombosis. On univariate analysis, Prothrombin time (PT)(p- < 0.001), Total-Leukocyte Count (p < 0.001) and age (p-0.045) were statistically significantly associated with ED secondary to bleeding and thrombosis. However, on multivariate analysis, only PT was significantly associated with ED due to bleeding/thrombosis (p-0.003). Even after excluding patients with ED, patients with a significant bleed/thrombosis at presentation had a lower Overall Survival than those without (p-0.005)(Figure 2).

    Conclusion(s): ED due to bleeding/thrombosis remains a challenge in improving outcomes of APL patients. We found a higher PT to be a predictor of early thrombo-hemorrhagic death.