Background: Recent advance in the treatment of childhood acute lymphoblastic leukemia (ALL) results in a substantially high remission rate. However, the outcomes in developing countries are relatively lower owing to the induction-related deaths secondary to either malignancy or infection-associated disseminated intravascular coagulation (DIC).

Aims: To investigate the risk factors predicting an occurrence of DIC following the induction chemotherapy in children with ALL.

Methods: The hospital records of children aged 1-15 years diagnosed with ALL and received chemotherapy between October 1^st, 2014 and September 30^th, 2019 were retrospectively reviewed. Patients were classified into two groups based on an occurrence of DIC according to the International Society of Thrombosis and Hemostasis criteria. Variables were compared between two groups using univariate analysis; multivariate logistic regression model were used to identify independent factors for DIC and the prediction capability was evaluated using a receiver operating characteristics (ROC). Ethics approval was obtained and informed consent was waived.

Results: Eighty-one children were included in the study; 12 (14.8%) with DIC and 69 (85.2%) without DIC. Age < 10 or ≥14 years, liver size ≥6 cm below costal margin, hypoalbuminemia (< 3.5 g/dL) at presentation, and chemotherapy regimen for high/very high risk ALL patients were associated with DIC in the univariate analysis. There was no difference in sex, bleeding at presentation, other presenting features, initial white blood cell count, ALL immunophenotype, or cytogenetics between two groups. Independent predictive factors associated with DIC in the multivariate analysis were age ≥14 years (OR 125.54, 95% CI 2.16-7303.95) and hypoalbuminemia at presentation (OR 52.76, 95% CI 4.1-679.35) (Table 1). The discriminative ability of the logistic model was shown by the ROC curve (Figure 1) with an area under the curve of 0.95.

Conclusions: Age ≥14 years and hypoalbuminemia at presentation were independently associated with DIC in children with ALL.

[Multivariate logistic regression results showing independent predictive factors of DIC in children with ALL]

[ROC curve of logistic regression model for the prediction of DIC in children with ALL]

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/predictive-factors-for-disseminated-intravascular-coagulation-in-childhood-acute-lymphoblastic-leukemia/