Background: Acute promyelocytic leukemia (APL) is frequently associated with disseminated intravascular coagulation (DIC), leading to potentially life-threatening bleeding. Compared to bleeding, thromboses are a less commonly encountered problem. Objective: The objective of our study was to identify the incidence and predictive value of demographic data, clinical–laboratory parameters, and thrombosis risk assessment models (RAMs) for venous thromboembolism (VTE) in patients with APL. Methods: This study was a retrospective study conducted on adult patients with APL who were treated between 2006 and 2024 at the Clinic of Hematology UCCS with all-trans retinoic acid (ATRA) and anthracycline. The demographic and clinical–laboratory data related to VTE were collected and analyzed alongside the predictive value of two RAMs proposed by Al-Ani and Paterno and colleagues. Results: Among the one-hundred-fifty-five adult patients with APL, VTE was diagnosed in twenty-eight cases (18.1%). The most common location for thrombosis was in the central venous catheter (CVC), which affected twelve (42.8%) patients. A total of six (21.4%) patients had deep vein thrombosis (DVT), one patient (3.6%) showed a pulmonary embolism (PE), and thrombosis at unusual sites was present in nine (32.1%) patients. Our analyses showed that neither Al-Ani’s RAM nor the RAM proposed by Paterno and colleagues were predictive for VTE in patients with APL. The C statistics value for the Al-Ani model was ROC = 0.514, and, for Paterno’s RAM, it was ROC = 0.521. The independent risk factors for VTE, identified via multivariate analysis, were CD114 expression (p= 0.005, OR = 6.4 IC 95%: [1.8–23.2]) and the absence of bleeding at presentation (p= 0.013, OR = 0.086 IC 95%: [0.01–0.59]). Conclusions: To the best of our knowledge, this is the first study showing that a higher expression of CD114 increases the risk of VTE. The absence of bleeding at presentation in patients with APL correlates with thrombosis. Further analyses are needed to confirm these findings and help to develop therapeutic strategies to prevent VTE complications. So far, no risk assessment model has been sufficient to stratify patients with APL according to their risk of VTE.
背景：急性早幼粒细胞白血病（APL）常并发弥散性血管内凝血（DIC），可能导致危及生命的出血。与出血相比，血栓形成是较为少见的问题。目的：本研究旨在确定APL患者静脉血栓栓塞（VTE）的人口统计学数据、临床-实验室参数及血栓风险评估模型（RAMs）的发生率和预测价值。方法：本研究为回顾性研究，对象为2006年至2024年间在UCCS血液科诊所接受全反式维甲酸（ATRA）和蒽环类药物治疗的成年APL患者。收集并分析与VTE相关的人口统计学和临床-实验室数据，同时评估Al-Ani及Paterno等学者提出的两种RAMs的预测价值。结果：在155例成年APL患者中，28例（18.1%）确诊VTE。血栓最常见部位为中心静脉导管（CVC），涉及12例（42.8%）患者。共有6例（21.4%）患者出现深静脉血栓（DVT），1例（3.6%）患者发生肺栓塞（PE），9例（32.1%）患者出现非典型部位血栓。分析显示，Al-Ani的RAM和Paterno等提出的RAM均不能预测APL患者的VTE风险。Al-Ani模型的C统计值为ROC=0.514，Paterno的RAM为ROC=0.521。通过多变量分析确定的VTE独立危险因素包括CD114表达（p=0.005，OR=6.4，95%CI：[1.8-23.2]）以及就诊时无出血症状（p=0.013，OR=0.086，95%CI：[0.01-0.59]）。结论：据我们所知，这是首次研究表明CD114高表达会增加VTE风险。APL患者就诊时无出血症状与血栓形成相关。需进一步分析以验证这些发现，并有助于制定预防VTE并发症的治疗策略。迄今为止，尚无风险评估模型足以根据VTE风险对APL患者进行分层。
Risk Factors for Venous Thromboembolism in Acute Promyelocytic Leukemia
肿瘤(癌症)患者之家