Cerebrovascular events in haematological diseases

Although hematological disorders are generally a relatively rare cause of stroke, an increased risk of cerebrovascular complications was observed in patients with these disorders.1 For example, in a 2019 study of patients with myeloproliferative neoplasms (MPNs), the 5-year risk of Vascular disease ranged from 0.5% to 7.7%, and the adjusted hazard rates in these individuals were 1.3 to 3.7 times higher than the general population.2 Stroke may be the first indication of an underlying MPN be the Journal of Neurology.1

In addition, leukemia can lead to ischemic or hemorrhagic strokes. Cerebral vein thrombosis (CVT) is the most common cause of cerebral infarction that occurs at the time of diagnosis in acute lymphoblastic leukemia. Risk factors include treatment with L-asparaginase, high-dose steroids, and intrathecal methotrexate. In patients with acute promyelocyte leukemia – in whom intracerebral bleeding is particularly common – the use of all-trans retinoic acid is the main risk factor for CVT.1

In a 2018 analysis based on the 2012 National Inpatient Sample, which consisted of more than 7 million hospital admissions, researchers found a 50-fold increase in stroke risk in patients with active acute myeloid leukemia (AML) compared to other patients in the sample fixed 3

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The results also showed higher mortality rates in AML patients with stroke compared to other patients (36.9% versus 6.7%; odds ratio 5.5; 95% CI 2.3-8.8; P <0.0001 ). Significant predictors of stroke included "acute kidney failure with tubular necrosis, hypernatremia, urinary tract infection and secondary thrombocytopenia," the study authors write.3

An increased risk of cerebrovascular accidents has also been observed in patients with lymphoma, multiple myeloma, sickle cell anemia, and various other haematological disorders. In addition to the increasing risk due to the pathogenesis of these diseases, the iatrogenic effects of associated therapies are a common cause of such events

Treating stroke in these individuals “requires close collaboration between hematologists, neurologists, neuroradiologists and sometimes neurosurgeons,” according to the study’s authors neurovascular disorder as well as immediate treatment is needed for the underlying hematological condition. “

To further discuss the risk and treatment of cerebrovascular events in this population, we spoke to Dr. Nduka Amankulor, Assistant Professor of Neurological Surgery and Director of the Neurosurgical Oncology Program at the University of Pittsburgh School of Medicine, Director of the Brain Tumor Immunogenetics Laboratory at the UPMC Hillman Cancer Center.

This article originally appeared on Hematology Advisor

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