Intracranial Hemorrhage in AL: A Major Problem With a Possible Solution

Middle meningeal artery (MMA) embolization is a novel, minimally invasive strategy that may help manage subdural hematomas (SDHs) in patients with acute leukemia (AL) with intracranial hemorrhage (ICH), according to a study presented at the 2023 American Society of Clinical Oncology Annual Meeting.

In this single-center, retrospective study, Binoy Yohannan and colleagues assessed 160 patients with AL (22 with ICH at presentation) at Memorial Hermann Hospital Texas Medical Center from January 2013 to December 2022. They collated patient data, including age at diagnosis, type of AL, white blood cell count (WBC), platelet count, coagulation profile, Glasgow Coma Scale score at presentation, response to platelet transfusion, need for minimally invasive surgical intervention, and mortality rates at 72 hours and 30 days.

Their analysis showed that the average age at diagnosis was 54 years. The median WBC count at admission was 23 × 10⁹/L (range, 0.2-400 × 10⁹/L). Thrombocytopenia (platelet levels <50,000/μL) was present in 16 patients, and 3 patients had platelet counts <10,000/μL. Of note, 3 patients had 2 or more types of ICH, and 3 patients had middle cerebral artery ischemic stroke in addition to ICH. One patient had myelofibrosis and myeloid sarcoma with bilateral subdural hematomas (SDHs) on admission, and that patient developed a fatal basal ganglia ICH during the course of chemotherapy. Overall, there was a 31% 30-day mortality rate among patients presenting with ICH.

“ICH in AL continues to be a major cause of mortality and morbidity. Early diagnosis, transfusion support, correction of coagulopathy, and neurosurgical expertise are critical in improving outcomes in AL-associated ICH. MMA embolization is a new, minimally invasive strategy for the management of SDH in these critically ill patients,” the researchers concluded.

Source: Yohannan B, Cervoni-Curet N, Martinez Gutierrez JC, Roc Chen P, Rios A. Intracranial hemorrhage (ICH) in acute leukemia (AL): a single-center study from a general hospital with two cases managed with middle meningeal artery (MMA) embolization. Abstract #19033. Published for the 2023 ASCO Annual Meeting; June 2-6, 2023; Chicago, Illinois.