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. 2021 May 21:13:4135-4146.
doi: 10.2147/CMAR.S309138. eCollection 2021.

Absolute Circulating Leukemic Cells as a Risk Factor for Early Bleeding Events in Patients with Non-High-Risk Acute Promyelocytic Leukemia

Yanru Pei #  1 , Mingyue Shi #  1 , Juanjuan Song  1 , Xiaona Niu  1 , Shengjie Wei  1 , Liurui Dou  1 , Mengyu Xiao  1 , Dan Li  1 , Fangfang Xu  1 , Yanliang Bai  1 , Kai Sun  1
Affiliations

Absolute Circulating Leukemic Cells as a Risk Factor for Early Bleeding Events in Patients with Non-High-Risk Acute Promyelocytic Leukemia

Yanru Pei et al. Cancer Manag Res. .

Abstract

Background: Hemorrhagic complications are the most common cause of early death in patients with APL and remain a major challenge in the management of APL. Early fatal bleeding events occur not only in high-risk but also in non-high-risk acute promyelocytic leukemia (APL) patients with normal or low WBC counts.

Objectives and methods: To demonstrate the role of the absolute number of circulating leukemic cells in early bleeding events in APL patients. Clinical and laboratory characteristics of 149 patients newly diagnosed with APL were obtained from medical records and retrospectively investigated.

Results: In this study, circulating absolute leukemic cells were positively correlated with the WBC count (r=0.9813, p<0.001) in all patients with APL, and importantly, they were strongly associated with significant bleeding events in non-high-risk patients. Multivariate logistic regression analysis showed that the absolute number of leukemia cells was an independent risk factor for significant bleeding events in APL patients. A cut-off value of 2.59×109/L for circulating leukemic cells to predict significant bleeding events in APL patients was obtained by ROC curve analysis. We further confirmed that the significant bleeding rate of patients with non-high-risk APL was statistically increased when the absolute number of circulating leukemic cells was ≥2.59×109/L.

Conclusion: Circulating leukemic cell content has great clinical value for predicting early bleeding events in APL patients, especially in non-high-risk APL.

Keywords: circulating leukemic cells; early fatal bleeding events; non-high-risk acute promyelocytic leukemia.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Circulating leukemic cells from peripheral blood smears of different patients  (A and B).
Figure 2
Figure 2
Laboratory data showed that there were significant differences in WBC count (A) and absolute number of circulating leukemic cells (B) between patients with or without significant bleeding.
Figure 3
Figure 3
Correlation of WBC count with circulating leukemic cell percentage and absolute number of circulating leukemic cells. There was no evident correlation between circulating leukemic cell percentage and WBC count in all APL patients (A), the high-risk group (C) or the non-high-risk group (E). The absolute number of circulating leukemic cells was positively correlated with the WBC count in all APL patients (B), the high-risk group (D) and the non-high-risk group (F).
Figure 4
Figure 4
Association between WBC count and bleeding events. The significant bleeding rate was higher in patients with WBC ≥10×109/L than in those with WBC <10×109/L.
Figure 5
Figure 5
Association between absolute number of circulating leukemic cells and bleeding events. The significant bleeding rate was higher in patients with an absolute number of circulating leukemic cells ≥2.59×109/L than in those with an absolute number of circulating leukemic cells <2.59×109/L in all patients with APL (A). In the non-high-risk group, the significant bleeding rate was higher in patients with peripheral blood promyelocyte counts ≥2.59×109/L (B).
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