Outcomes and Clinical Characteristics of Intracranial Hemorrhage in Patients with Hematologic Malignancies: A Systematic Literature Review

Alankrita Raghavan; Christina H Wright; James M Wright; Kelsey Jensen; Patrick Malloy; Theresa Elder; Christopher Burant; Martha Sajatovic; Alan Hoffer

doi:10.1016/j.wneu.2020.06.091

Outcomes and Clinical Characteristics of Intracranial Hemorrhage in Patients with Hematologic Malignancies: A Systematic Literature Review

World Neurosurg. 2020 Dec:144:e15-e24. doi: 10.1016/j.wneu.2020.06.091. Epub 2020 Jun 18.

Authors

Alankrita Raghavan¹, Christina H Wright², James M Wright³, Kelsey Jensen⁴, Patrick Malloy¹, Theresa Elder³, Christopher Burant¹, Martha Sajatovic⁵, Alan Hoffer³

Affiliations

¹ Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
² Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA. Electronic address: Christina.wright@uhhospitals.org.
³ Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
⁴ Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA.
⁵ Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Neurological and Behavioral Outcomes Center, Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.

PMID: 32565374
DOI: 10.1016/j.wneu.2020.06.091

Abstract

Background: Many clinical and demographic factors can influence survival of patients with hematologic malignancies who have intracranial hemorrhages (ICHs). Understanding the influence of these factors on patient survival can guide treatment decisions and may inform prognostic discussions. We conducted a systematic literature review to determine survival of patients with intracranial hemorrhages and concomitant hematologic malignancy.

Methods: A systematic literature review was conducted and followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PubMed/MEDLINE, Web of Science, Ovid, SCOPUS, and Embase databases were queried with the following terms: ("intracranial hemorrhages" OR "brain hemorrhage" OR "cerebral hemorrhage" OR "subdural hematoma" OR "epidural hematoma" OR "intraparenchymal hemorrhage") AND ("Hematologic Neoplasms" OR "Myeloproliferative Disorders" OR "Myelofibrosis" OR "Essential thrombocythemia" OR "Leukemia"). Abstracts and articles were screened according to inclusion and exclusion criteria that were determined a priori.

Results: Literature review yielded 975 abstracts from which a total of 68 full-text articles were reviewed. Twelve articles capturing 634 unique patients were included in the final qualitative analysis. Median overall survival for all patients ranged from 20 days to 1.5 months while median overall survival for the subset of patients having ICH within 10 days of diagnosis of hematologic malignancy was 5 days. Intraparenchymal hemorrhages, multiple foci of hemorrhage, transfusion-resistant low platelet counts, leukocytosis, low Glasgow Coma Scale scores at presentation, and ICH early in treatment course were associated with worse outcomes.

Conclusions: Survival for patients with hematologic malignancies and concomitant ICHs remains poor. Early detection, recognition of poor prognostic factors, and correction of hematologic abnormalities essential to prevention and treatment of ICHs in this patient population.

Keywords: Hematologic malignancies; Intracranial hemorrhage.

Publication types

Systematic Review

MeSH terms

Hematologic Neoplasms / complications*
Hematologic Neoplasms / mortality
Humans
Intracranial Hemorrhages / etiology
Intracranial Hemorrhages / mortality
Intracranial Hemorrhages / therapy*
Prognosis
Survival Analysis
Treatment Outcome