Background
Venous thromboembolism (
VTE
) is relatively common in children with acute lymphoblastic leukemia (
ALL
). Thrombotic risk factors in
ALL
are asparaginase and steroids. However, within the
ALL
populations treated on the same regimen, it is less clear which other risk factors play a role. Furthermore, few data are available on the effect of
VTE
on
ALL
outcomes.
Methods
In 778 children (1‐18 years) with newly diagnosed precursor‐B‐lineage or T‐lineage
ALL
, treated in the Dutch Childhood Oncology Group (
DCOG
)
ALL
‐10 protocol in the Netherlands (October 2004 to April 2013), we conducted a nested case control study with 59 VTE cases and 118 controls to identify risk factors for
VTE
.
Results
Fifty‐nine of 778
ALL
patients developed
VTE
(7.6%), with cerebral venous sinus thrombosis (
CVST
) in 26 of 59 patients (44.1%).
VTE
occurred during induction treatment in 59.3% (n = 35) and in 40.7% (n = 24) during medium risk intensification. Conditional multivariable logistic regression analysis showed that age and
ALL
subtype were significantly associated with
VTE
(age ≥7 years:
OR
2.72, 95%
CI
1.33‐5.57;
ALL
subtype T‐
ALL
:
OR
2.95, 95%
CI
1.02‐8.57). A multivariable Cox model showed no association between the occurrence of
VTE
and event free survival. In
CVST
patients, permanent disability was present in 34.6%.
Conclusion
Within this large pediatric
ALL
cohort, we demonstrated a high morbidity in
CVST
patients. Age ≥7 years at diagnosis and T‐
ALL
subtype were the main risk factors for
VTE
, and should be considered in preventive strategies.
The etiology of pediatric venous thromboembolic disease (VTE) is multifactorial, and in most children, 1 or more clinical risk factors are present. In addition, inherited thrombophilic disorders contribute to the development of pediatric VTE. In this review, the role of inherited thrombophilic disorders in the development of pediatric VTE, as well as the benefits and limitations of thrombophilia testing, will be discussed.
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