Cerebral sinovenous thrombosis in children and young adults with acute lymphoblastic leukaemia – a cohort study from the United Kingdom

Musgrave, Kathryn M.; Delft, Frederik W. van; Avery, Peter; Clack, Rachel; Chalmers, Elizabeth; Qureshi, Amrana; Vora, Ajay; Biss, Tina

doi:10.1111/bjh.14231

Cited by 28 publications

(47 citation statements)

References 11 publications

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“…A large meta‐analysis of 17 prospective studies comprising 1,752 pediatric patients reported a global rate of 2.9% (95% CI: 2.2–3.8) while two recent studies from the United Kingdom and the Nordic Society of Pediatric Hematology and Oncology (NOPHO) reported an incidence of 1.4 and 1.9%, respectively . We believe that the high incidence in our cohort is due to combined treatment‐ and patient‐related factors.…”

Section: Discussionmentioning

confidence: 69%

“…while two recent studies from the United Kingdom and the Nordic Society of Pediatric Hematology and Oncology (NOPHO) reported an incidence of 1.4 and 1.9%, respectively. 3,6 We believe that the high incidence in our cohort is due to combined treatment-and patient-related factors. The most important factor is the relatively intensive therapy that includes prolonged exposure to large doses of ASP in combination with steroids, especially for intermediate-/high-risk patients.…”

Section: Outcomementioning

confidence: 89%

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Cerebral sinus venous thrombosis during childhood acute lymphoblastic leukemia therapy: Risk factors and management

Ghanem

Dhayni

Al-Aridi

et al. 2017

Pediatric Blood & Cancer

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Section: Discussionmentioning

confidence: 69%

Section: Outcomementioning

confidence: 89%

Cerebral sinus venous thrombosis during childhood acute lymphoblastic leukemia therapy: Risk factors and management

Ghanem

Dhayni

Al-Aridi

et al. 2017

Pediatric Blood & Cancer

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“…It is ambiguous if reintroduction of asparaginase after VTE is safe. Two studies described reintroduction of asparaginase, in which most patients received LMWH prophylaxis and no recurrent thrombosis occurred 38,39 . However, another study described a high VTE recurrence rate, despite anticoagulant therapy 18 .…”

Section: Discussionmentioning

confidence: 99%

Venous thromboembolism in a large cohort of children with acute lymphoblastic leukemia: Risk factors and effect on prognosis

Klaassen

Lauw

Fiocco

et al. 2019

Research and Practice in Thrombosis and Haemostasis

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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.

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“…Risk factors for TE include the leukemia itself, older age, central line catheters, immobilization, infections, systemic inflammation, and therapy with asparaginase or corticosteroids or both 76, 90, 93, 95, 96 , whereas inherited thrombophilia risk factors, including common germline DNA polymorphisms, do not seem to play a role or at best remain uncertain 96 . The fatality rate of venous TE is highest in children with thromboses in cerebral veins, and studies on the benefits of anti-thrombotic prophylaxis, preferably with the novel oral anti-coagulants, are needed 90, 97, 98 .…”

Section: Thromboembolismsmentioning

confidence: 99%

Non-infectious chemotherapy-associated acute toxicities during childhood acute lymphoblastic leukemia therapy

et al. 2017

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During chemotherapy for childhood acute lymphoblastic leukemia, all organs can be affected by severe acute side effects, the most common being opportunistic infections, mucositis, central or peripheral neuropathy (or both), bone toxicities (including osteonecrosis), thromboembolism, sinusoidal obstruction syndrome, endocrinopathies (especially steroid-induced adrenal insufficiency and hyperglycemia), high-dose methotrexate-induced nephrotoxicity, asparaginase-associated hypersensitivity, pancreatitis, and hyperlipidemia. Few of the non-infectious acute toxicities are associated with clinically useful risk factors, and across study groups there has been wide diversity in toxicity definitions, capture strategies, and reporting, thus hampering meaningful comparisons of toxicity incidences for different leukemia protocols. Since treatment of acute lymphoblastic leukemia now yields 5-year overall survival rates above 90%, there is a need for strategies for assessing the burden of toxicities in the overall evaluation of anti-leukemic therapy programs.

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Cerebral sinovenous thrombosis in children and young adults with acute lymphoblastic leukaemia – a cohort study from the United Kingdom

Cited by 28 publications

References 11 publications

Cerebral sinus venous thrombosis during childhood acute lymphoblastic leukemia therapy: Risk factors and management

Cerebral sinus venous thrombosis during childhood acute lymphoblastic leukemia therapy: Risk factors and management

Venous thromboembolism in a large cohort of children with acute lymphoblastic leukemia: Risk factors and effect on prognosis

Non-infectious chemotherapy-associated acute toxicities during childhood acute lymphoblastic leukemia therapy

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