Von Willebrand, factor VIII, and D-dimer levels as predictors of risk and clinical outcomes in acute myeloid leukemia.

Coagulopathies, infection, and CNS infiltration are common complications during induction therapy of acute myeloid leukemia (AML). Early identification of adverse-risk patients may improve outcomes. This study evaluated the predictive value of coagulation markers, von Willebrand Factor antigen (vWF-ag), von Willebrand Factor-ristocetin cofactor (vWF-RCof), antihemophilic factor (FVIII), and D-dimer on risk stratification, severity and outcomes of AML patients. Fifty AML patients treated at Oncology Center Mansoura University hospital, from February 2023 to February 2024 were recruited and stratified into three risk groups favourable, intermediate, and adverse risk groups respectively according to the 2022 European leukemianet (ELN) risk stratification for AML. vWF-ag, vWF: RCof, FVIII, and D-dimer were measured at diagnosis and at remission. Adverse-risk group had the highest median levels of vWF-ag, vWF-RCof, FVIII and D-dimer at, both diagnosis and remission (p < 0.05). All markers significantly declined after remission (p < 0.05). vWF-ag, vWF-RCof, and D-dimer differed significantly among risk groups at both diagnosis and remission. ROC analysis showed that in the adverse-risk group, D-dimer had an AUC of 0.813 (cutoff > 1.6), vWF: Ag 0.780 (> 295), and vWF: RCo 0.761 (> 223). FVIII showed lower predictive value (AUC 0.625). Infection was the most frequent complication, followed by bleeding and thrombosis. Infection correlated with higher vWF: Ag after remission; thrombosis correlated with elevated vWF: Ag at diagnosis and remission and bleeding with lower vWF-ag. CNS infiltration showed no association. vWF-ag, vWF-RCof, and D-dimers may be associated with risk and complications in AML, but these findings require external validation in larger cohorts.