Symptomatic Cerebral Sinovenous Thrombosis Associated With l-Asparaginase In Children With Acute Lymphoblastic Leukemia: A Single Institution Experience Over 17 Years

Malhotra, Payal; Jain, Sandeep; Kapoor, Gauri

doi:10.1097/mph.0000000000001127

Cited by 14 publications

(14 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The overall mortality rate in ALL patients as a result of VTE varies between 0% and 4.8% . A substantial proportion of VTE in ALL is due to cerebral venous sinus thrombosis (CVST) with a reported mortality between 0% and 28% . Morbidity includes recurrent thrombosis, neurologic changes, catheter removal, bleeding due to antithrombotic agents, and the development of the postthrombotic syndrome .…”

Section: Introductionmentioning

confidence: 99%

“…6 A substantial proportion of VTE in ALL is due to cerebral venous sinus thrombosis (CVST) with a reported mortality between 0% and 28%. [8][9][10][11] Morbidity includes recurrent thrombosis, neurologic changes, catheter removal, bleeding due to antithrombotic agents, and the development of the postthrombotic syndrome. [12][13][14]15 Furthermore, VTE can lead to suboptimal ALL therapy, due to the necessity to interrupt, delay, or even discontinue chemotherapy, and thereby to inferior disease outcomes.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

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

View full text Add to dashboard Cite

show abstract

“…Patients with ALL may develop thrombi in different parts of the body. 3 CVST is a rare complication of ALL, which may lead to death, 10 and the clinical symptom are nausea, vomiting, headache, seizures, lethargy, and altered consciousness. 11 CVST can also be asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

View full text Add to dashboard Cite

Acute lymphoblastic leukemia (ALL) is a hematological malignancy. There are many risk factors for thrombus development in patients with ALL, and thrombi may develop in different parts of the body. Cerebral venous sinus thrombosis (CVST) is a rare complication of ALL that usually appears during treatment. We present a patient who developed CVST twice, once before diagnosis and once after treatment for ALL. We also reviewed the literature describing ALL and CVST.

show abstract

“…4 30 In 25% of the cases, VTE occurred as a CSVT, a potentially severe complication, with a high case-fatality rate of 0 to 29%. 31 32 33 The incidence of CSVT in ALL patients is considerably higher compared with the normal pediatric population. 33 Previous studies have shown that patients during ALL treatment are at an increased risk for CSVT.…”

Section: Discussionmentioning

confidence: 99%

“…32 33 35 As in the study by Abbott et al, the current study did not seem to show beneficial effect of FFP for the prevention of CSVT. 31…”

Section: Discussionmentioning

confidence: 99%

Venous Thrombosis in Children with Acute Lymphoblastic Leukemia Treated on DCOG ALL-9 and ALL-10 Protocols: The Effect of Fresh Frozen Plasma

Klaassen

Zuurbier

Hutten

et al. 2019

TH Open

View full text Add to dashboard Cite

Background Venous thromboembolism (VTE) is an important complication for treatment of acute lymphoblastic leukemia (ALL) in children. Especially, ALL treatment, with therapeutics such as asparaginase and steroids, increases the thrombotic risk by reduction in procoagulant and anticoagulant proteins. Replacement of deficient natural anticoagulants by administration of fresh frozen plasma (FFP) may have a preventive effect on the occurrence of VTE. Methods We retrospectively analyzed all consecutive children (≤18 years) with ALL, treated on the Dutch Childhood Oncology Group (DCOG) ALL-9 and ALL-10 protocols at the Emma Children's Hospital Academic Medical Center between February 1997 and January 2012, to study the effect of FFP on VTE incidence, antithrombin and fibrinogen plasma levels, and VTE risk factors. Results In total, 18/205 patients developed VTE (8.8%; 95% confidence interval [CI]: 4.9–12.7%). In all patients, VTE occurred after asparaginase administration. In total, 82/205 patients (40%) received FFP. FFP supplementation did not prevent VTE or alter plasma levels of antithrombin or fibrinogen. In the multivariate analysis, VTE occurred significantly more frequently in children ≥12 years (odds ratio [OR]: 3.89; 95% CI: 1.29–11.73) and treated according to the ALL-10 protocol (OR: 3.71; 95% CI: 1.13–12.17). Conclusion FFP supplementation does not seem to be beneficial in the prevention of VTE in pediatric ALL patients. In addition, age ≥12 years and treatment according to the DCOG ALL-10 protocol with intensive and prolonged administration of asparaginase in combination with prednisone are risk factors. There is a need for effective preventive strategies in ALL patients at high risk for VTE.

show abstract

Symptomatic Cerebral Sinovenous Thrombosis Associated With l-Asparaginase In Children With Acute Lymphoblastic Leukemia: A Single Institution Experience Over 17 Years

Cited by 14 publications

References 14 publications

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

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

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

Venous Thrombosis in Children with Acute Lymphoblastic Leukemia Treated on DCOG ALL-9 and ALL-10 Protocols: The Effect of Fresh Frozen Plasma

Contact Info

Product

Resources

About