Cerebral venous sinus thrombosis in a young child with acute lymphoblastic leukemia: a case report and literature review

Liu, Jingwei; Yang, Chun‐Feng; Zhang, Zhen; Li, Yumei

doi:10.1177/0300060520986291

Cited by 4 publications

(5 citation statements)

References 25 publications

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“…Clinical findings of thrombosis may be confusing with drug-related neurologic side effects and symptoms of CNS involvement in ALL. 4,26 In our study, headache, seizure, and alternating consciousness were the most common clinical symptoms in patients with CNS thrombosis. However, different neurological symptoms such as vomiting, vision and speech disorder, facial paralysis, hemiparesis, weakness, personality changes, dizziness, and numbness in the extremities were observed at varying rates.…”

Section: Discussionmentioning

confidence: 52%

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Central nervous system thrombosis in pediatric acute lymphoblastic leukemia in Turkey: A multicenter study

Güzelküçük¹,

Karapınar

Gelen

et al. 2023

Pediatric Blood & Cancer

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Background: In patients with acute lymphoblastic leukemia (ALL), the risk of thromboembolism increases due to hemostatic changes secondary to the primary disease and due to treatment-related factors. In this multicenter study, we aimed to research the frequency of central nervous system (CNS) thrombosis occurring during treatment, hereditary and acquired risk factors, clinical and laboratory features of patients with thrombosis, treatment approaches, and thrombosis-related mortality and morbidity rates in pediatric ALL patients. Procedure: Pediatric patients who developed CNS thrombosis during ALL treatment from 2010 to 2021 were analyzed retrospectively in 25 different Pediatric Hematology Oncology centers in Türkiye. The demographic characteristics of the patients, symptoms associated with thrombosis, the stage of the leukemia treatment during thrombosis, the anticoagulant therapy applied for thrombosis, and the final status of the patients recorded through electronic medical records were determined.Results: Data from 70 patients with CNS thrombosis during treatment, out of 3968 pediatric patients with ALL, were reviewed. The incidence of CNS thrombosis was 1.8% (venous: 1.5 %; arterial: 0.03%). Among patients with CNS thrombosis, 47 had the event in the first 2 months. Low molecular weight heparin (LMWH) was the most commonly used treatment with a median of 6 months (min-max: 3-28 months). No treatment-related complications occurred. Chronic thrombosis findings occurred in four patients (6%). In five (7%) patients who developed cerebral vein thrombosis, neurological sequelae (epilepsy and neurological deficit) remained. One patient died related to thrombosis, and the mortality rate was 1.4%. Conclusion:Cerebral venous thrombosis and, less frequently, cerebral arterial thrombosis may develop in patients with ALL. The incidence of CNS thrombosis is higher during induction therapy than during other courses of treatment. Therefore, patients receiving induction therapy should be monitored carefully for clinical findings suggestive of CNS thrombosis.

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Section: Discussionmentioning

confidence: 52%

“…Clinical findings of thrombosis may be confusing with drug‐related neurologic side effects and symptoms of CNS involvement in ALL 4,26 . In our study, headache, seizure, and alternating consciousness were the most common clinical symptoms in patients with CNS thrombosis.…”

Section: Discussionmentioning

confidence: 60%

Central nervous system thrombosis in pediatric acute lymphoblastic leukemia in Turkey: A multicenter study

Güzelküçük¹,

Karapınar

Gelen

et al. 2023

Pediatric Blood & Cancer

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“…The risk of thrombosis increases by eight times if only one thrombophilia factor is present [ 9 ]. Our patient’s recent asparaginase treatment placed him at an increased risk of CVST, as asparaginase chemotherapy causes natural anticoagulant deficiency [ 10 ]. So, this shifts our minds from considering direct infiltration as the primary cause of retinal hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…The treatment was stopped as well, and a repeated CT brain was performed after one month of stopping the treatment showing normal results [ 5 ]. Similarly, Liu et al stopped the asparaginase therapy when their patient developed severe thrombosis and signs of CVST [ 10 ]. Additionally, another study concluded that receiving less asparaginase therapy improves the outcomes substantially [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Masquerade of Leukemic Infiltration With Cerebral Sinus Venous Thrombosis Causing Papilledema by Asparaginase Therapy

Abumohssin¹,

Alnabihi²,

Alqahtani³

2023

Cureus

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Acute lymphoblastic leukemia (ALL) is a hematological cancer that can cause ocular tissue involvement. Asparaginase is a chemotherapy regimen that is commonly used in leukemia which could lead to similar ocular manifestations. We report a patient with a history of ALL for seven months on asparaginase therapy and persistent cerebral sinus venous thrombosis (CSVT) with acute venous infarction in the left frontal lobe presented with worsening vision. On examination, he had a visual acuity (VA) of (6/21) in the right eye and (6/60) in the left eye, with a mild left eye abduction limitation. Fundal examination showed bilateral prominent multilayered retinal hemorrhages and papilledema with absence of leukemic infiltration. His chemotherapy regimen was held and a one month follow up was scheduled. Follow up after one month of chemotherapy cessation showed resolution of both VA and fundal exam findings. It is crucial to differentiate between asparaginase toxicity and infiltration of the disease in ALL patients. As this would determine whether the treatment should be continued or suspended.

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“…Asparaginase and steroids are significant risk factors for venous thromboembolism (VTE), as they interfere with levels of natural anticoagulants leading to suboptimal treatment responses in ALL patients, and there are currently no proven preventive strategies for VTE during ALL treatment [ 69 , 70 , 71 ]. Antibodies to asparaginase lead to disease relapse [ 72 ].…”

Section: Reviewmentioning

confidence: 99%

A Review of Acute Lymphocytic Leukemia (ALL) in the Pediatric Population: Evaluating Current Trends and Changes in Guidelines in the Past Decade

Ekpa,

Akahara,

Anderson

et al. 2023

Cureus

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Acute lymphocytic leukemia (ALL) is a commonly diagnosed cancer in children. Despite technological advancements to improve treatment and survival rates, there has been a steady increase in the incidence of ALL and treatment failures. This paper discusses the pathogenic interaction between genetic and environmental factors leading to childhood ALL. It evaluates the current treatment guidelines and notable obstacles leading to resistance, relapse, and treatment toxicities. The review evaluates a 10-year trend in the management guidelines of pediatric ALL through a systematic literature review of records from 2012 to 2023. Findings show that improvement in the five-year survival rates, notwithstanding rates of relapse and incurable diseases, is still high. Furthermore, several risk factors, including an interplay between genetic and environmental factors, are largely contributory to the outcome of ALL treatments and its overall incidence. Moreover, huge financial costs have remained a significant challenge in outcomes. There remains a need to provide individualized treatment plans, shared decision-making, and goals of care as parts of the management guidelines for the best possible outcomes. We expect that future advancements will increase overall survival rates and disease-free years.

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Cerebral venous sinus thrombosis in a young child with acute lymphoblastic leukemia: a case report and literature review

Cited by 4 publications

References 25 publications

Central nervous system thrombosis in pediatric acute lymphoblastic leukemia in Turkey: A multicenter study

Central nervous system thrombosis in pediatric acute lymphoblastic leukemia in Turkey: A multicenter study

Masquerade of Leukemic Infiltration With Cerebral Sinus Venous Thrombosis Causing Papilledema by Asparaginase Therapy

A Review of Acute Lymphocytic Leukemia (ALL) in the Pediatric Population: Evaluating Current Trends and Changes in Guidelines in the Past Decade

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