Cerebral sinus venous thromboses in children with acute lymphoblastic leukaemia – a multicentre study from the Nordic Society of Paediatric Haematology and Oncology

Ranta, Susanna; Tuckuviene, Ruta; Mäkipernaa, Anne; Albertsen, Birgitte Klug; Frisk, Tony; Tedgård, Ulf; Jónsson, Òlafur G.; Pruunsild, Kaie; Andersson, Nadine G.; Gunnes, Maria Winther; Trakymienė, Sonata Šaulytė; Frandsen, Thomas Leth; Heyman, Mats; Ruud, Ellen; Helgestad, Jon

doi:10.1111/bjh.13162

Cited by 71 publications

(96 citation statements)

References 13 publications

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“…Prophylactic anticoagulation did not seem to protect from CNS thrombosis, as it was performed in 90% of patients with CNS thrombosis and in only 64.9% of the patients without CNS thrombosis 29. The 3.1% rate of CNS thrombosis seen in this study is higher than the 1%–2% incidence rate reported in children30 (see Table 2 for additional asparaginase side effects and recommended management).…”

Section: Thrombotic Complicationscontrasting

confidence: 59%

Safety, efficacy, and clinical utility of asparaginase in the treatment of adult patients with acute lymphoblastic leukemia

Koprivnikar

McCloskey

Faderl

2017

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Adults with acute lymphoblastic leukemia (ALL) are known to have inferior outcomes compared to the pediatric population. Although the reasons for this are likely manyfold, the agents utilized and the increased intensity of pediatric treatments compared to adult treatments are likely significant contributing factors. Asparaginase, an enzyme that converts asparagine to aspartic acid, forms the backbone of almost all pediatric regimens and works by depleting extracellular asparagine, which ALL cells are unable to synthesize. Asparaginase toxicities, which include hypersensitivity reactions, pancreatitis, liver dysfunction, and thrombosis, have hindered its widespread use in the adult population. Here, we review the toxicity and efficacy of asparaginase in adult patients with ALL. With the proper precautions, it is a safe and effective agent in the treatment of younger adults with ALL with response rates in the frontline setting ranging from 78% to 96%, compared to most trials showing a 4-year overall survival of 50% or better. The age cutoff for consideration of treatment with pediatric-inspired regimens is not clear, but recent studies show promise particularly in the adolescent and young adult population. New formulations of asparaginase are actively in development, including erythrocyte-encapsulated asparaginase, which is designed to minimize the toxicity and improve the delivery of the drug.

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Section: Thrombotic Complicationscontrasting

confidence: 59%

Safety, efficacy, and clinical utility of asparaginase in the treatment of adult patients with acute lymphoblastic leukemia

Koprivnikar

McCloskey

Faderl

2017

OTT

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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 venous sinus thrombosis may be seen following the use of L-asparaginase use and/or steroids. 9 …”

Section: Headachementioning

confidence: 99%

Neurological Complications of Pediatric Cancer

2016

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Neurologists are often consulted for diagnosis and management of neurologic complications in patients undergoing therapy for cancer. Pediatric patients with cancer, often undergoing the same types of therapy as adults with cancer, may experience different adverse events. The set of neurologic complications in children differs from that in adults and the neurologist must take into account the continuing growth and development of the patient as well as significant differences in primary diagnosis across the population. Correctly recognizing complications and initiating prompt treatment may reduce pain and prevent further progression and permanent deficits. Herein, we review the most recent literature on the neurological complications of cancer therapy organized by frequency in the pediatric population.

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Cerebral sinus venous thromboses in children with acute lymphoblastic leukaemia – a multicentre study from the Nordic Society of Paediatric Haematology and Oncology

Cited by 71 publications

References 13 publications

Safety, efficacy, and clinical utility of asparaginase in the treatment of adult patients with acute lymphoblastic leukemia

Safety, efficacy, and clinical utility of asparaginase in the treatment of adult patients with acute lymphoblastic leukemia

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

Neurological Complications of Pediatric Cancer

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