PB1017 - Basophil-lineage commitment marker CD203c and ISTH-DIC score ≥6 predicts higher intracranial hemorrhage risk and higher progression to DIC in acute promyelocytic leukemia (APL)

Tuesday, June 25, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

Vandana Puri Tiwari, DR

Senior resident (Academic)
All India Institute of Medical Sciences, New Delhi
New Delhi, Delhi, India

Co-Author(s)

JD

Jasmita Dass, MD, DM

Associate Professor of Hematopathology
All India Institute of Medical Sciences, New Delhi
New Delhi, Delhi, India
MA

Mukul Aggarwal

Assistant Professor
All India Institute of Medical Sciences, New Delhi
Delhi, Delhi, India
CY

Charu Yadav

Consultant
Medanta, the Medicity
New Delhi, Delhi, India
GV

Ganesh Kumar Viswanathan

Associate Professor
All India Institute of Medical Sciences, New Delhi
New Delhi, Delhi, India
ST

Seema Tyagi

Professor
All India Institute of Medical Sciences
New Delhi, Delhi, India
PK

Pradeep Kumar

Associate Professor
All India Institute of Medical Sciences, New Delhi
New Delhi, Delhi, India
RD

Rishi Dhawan

Associate professor
All India Institute of Medical Sciences, New Delhi
New Delhi, Delhi, India
RC

Richa Chauhan

Assistant Professor
All India Institute of Medical Sciences, New Delhi
New Delhi, Delhi, India
RP

Roy J. Palatty

Consultant
Rajiv Gandhi Cancer Institute
New Delhi, Delhi, India
TS

Tulika Seth

Professor
All India Institute of Medical Sciences, New Delhi
New Delhi, Delhi, India
MM

Manoranjan Mahapatra

Professor and Head
All India institute of Medical Sciences, New Delhi
New Delhi, Delhi, India

Background: Acute promyelocytic leukemia (APL) patients with all trans retinoic acid (ATO) and arsenic trioxide have higher remission rates and overall survival (OS) but early deaths (ED) during induction remain an unsolved problem. One of the major causes for ED in APL is life-threatening hemorrhage especially intracranial hemorrhage (ICH). The identification of independent predictors of severe bleeding and very ED (within seven days of induction) at diagnosis remains a challenge. Previous studies have suggested that basophil-associated phenotypic characteristic of CD203c expression on ≥2% bone marrow APL cells and ISTH-DIC score were significantly associated with the occurrence of bleeding.

Aims: To assess baseline coagulation parameters and immunophenotypic expression of CD203c in APL at diagnosis within 24 hours of starting therapy and correlate it with DIC profile and ICH.

Methods: 49 newly diagnosed APL patients (Table 1) were accrued and underwent hemogram and coagulation tests. Immunophenotypic analysis for CD203c on APL was done on peripheral blood (PB)/ bone marrow leukemic cells. Receiver operating characteristic curves (ROC) of CD203c were used to establish cut-off values to predict for ICH and ED.

Results: Factors that correlated with ICH at diagnosis included white blood cell count (WBC), PT, hypofibrinogenemia, PB promyelocyte percentage, ISTH-DIC score ≥6, CD203c expression of ≥10.85%, and reticulin fibrosis (RF). To predict ICH developing/ extending during induction, WBC count, PB promyelocyte percentage, CD203c expression ≥10.85%, and RF retained significance and CD203c≥2% became borderline significant (Table 2). CD203c expression at both cut-offs correlated with ED. On multivariate analysis, CD203c≥10.85%, ISTH-DIC score ≥6, and RF emerged as predictors of mortality.

Conclusion(s): ISTH-DIC score ≥6 is a better predictor of ICH at diagnosis than the conventional cut-off of ≥5. CD203c expression ≥10.85% predicts ICH at diagnosis and during induction therapy. Both these factors are also independent predictors of mortality on multivariate analysis.