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Thromb J. 2019 Jul 2;17:13. doi: 10.1186/s12959-019-0202-z. eCollection 2019.

Validation of the Khorana score in acute myeloid leukemia patients: a single-institution experience.

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1Department of Internal Medicine, H. Lee Moffitt Cancer Center and Research Institution, University of South Florida, 17 Davis Blvd., Suite 308, Tampa, FL 33606 USA.
2Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institution, Tampa, FL USA.
3Morsani College of Medicine, University of South Florida, Tampa, FL USA.
4College of Arts and Sciences, University of South Florida, Tampa, FL USA.



Although patients with acute myeloid leukemia (AML) were shown to have an increased risk of thrombosis, no thrombosis risk assessment scoring system has been developed for AML patients. The Khorana Risk Score (KRS), which has been widely used for thrombosis risk assessment in the clinical setting, was developed on the basis of solid tumor data and has not been validated among AML patients. This study aims to validate the use of the KRS as a thrombosis risk-scoring system among patients with AML.


Using data from H. Lee Moffitt Cancer Center and Research Institution's Total Cancer Care Research Study, we retrospectively identified patients who were histologically confirmed with AML from 2000 to 2018. Clinical and laboratory variables at the time of AML diagnosis were characterized and analyzed. The thrombotic event rate was estimated with the Kaplan-Meier method and compared using the log-rank test.


A total of 867 AML patients were included in the analysis. The median age at AML diagnosis was 75 years (range, 51-96), and the majority were male (65%, n = 565). A total of 22% (n = 191), 51% (n = 445), 24% (n = 207), and 3% (n = 24) of patients had a KRS of 0, 1, 2, and 3, respectively. A total of 42 thrombotic events (3% [n = 6/191] with a KRS of 1; 5% [n = 23/445] with a KRS of 2; 6.3% [n = 13/207] with a KRS of 3) were observed, with a median follow-up of 3 months (range, 0.1-307). There was no statistical difference in the risk of thrombosis between these groups (P = .1949).


Although there was an increased risk of thrombosis associated with a higher KRS among AML patients with a KRS of 1 to 3, the difference was not statistically significant. Furthermore, only a few patients were found to have a KRS > 3, and this was largely due to pancytopenia, which is commonly associated with AML. These results indicate the need for a better thrombotic risk-scoring system for AML patients.


Acute myeloid leukemia; Khorana score; Risk prediction; Thrombosis

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

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