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Annals of Oncology Advance Access originally published online on March 8, 2009
Annals of Oncology 2009 20(6):1100-1104; doi:10.1093/annonc/mdn755
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

quality of life/supportive care/palliative care

Prediction of fatal intracranial hemorrhage in patients with acute myeloid leukemia

C.-Y. Chen1, C.-H. Tai2, W. Tsay1, P.-Y. Chen3 and H.-F. Tien1,*

1 Department of Internal Medicine, Division of Hematology
2 Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
3 Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan

* Correspondence to: Dr H.-F. Tien, Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan. Tel: +886-2-23123456; Fax: +886-2-23959583; E-mail: hftien{at}ntu.edu.tw

Background: Intracranial hemorrhage (ICH) is the second leading cause of mortality in patients with acute myeloid leukemia (AML). However, the prognostic factors for ICH in AML patients are still under investigation.

Patients and methods: A total of 841 AML patients admitted to the Department of Internal Medicine from January 1995 to December 2007 were enrolled in this study.

Results: There were 51 patients with ICH, median age of 51 (range 17–86), including 12 patients diagnosed as acute promyelocytic leukemia. Forty-three patients were refractory/relapsed status. ICH was localized in the supratentorium (44 cases), basal ganglion (9), cerebellum (5), and brainstem (4). Twenty-one patients had multiple sites. Thirty-eight patients had intraparenchymal hemorrhage, 16 subarachnoid hemorrhage (SAH), 10 subdural hemorrhage, and one epidural hemorrhage (EDH). Hemorrhage ruptured into the ventricles in 13 patients. Thirty-four patients (67%) died of ICH within 30 days of diagnosis. Multivariate analysis revealed four independent prognostic factors, prolonged prothrombin time international normalized ratio >1.5 (P < 0.001), brainstem hemorrhage (P = 0.001), SAH (P = 0.017), and EDH (P = 0.014). Other clinico-laboratory data had no impact on 30-day survival.

Conclusions: ICH has high morbidity and mortality in AML. Early detection and aggressive correction coagulopathy may prevent the catastrophic event. Prompt image study for locations and types of ICH can predict outcomes.

Key words: acute myeloid leukemia, cerebral hemorrhage, prognosis

Received for publication November 6, 2008. Accepted for publication November 18, 2008.


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