Thrombotic and hemorrhagic strokes complicating early therapy for childhood acute lymphoblastic leukemia

Priest, John R.; Ramsay, Norma K.C.; Latchaw, Richard E.; Lockman, Lawrence A.; Hasegawa, Duane K.; Coates, Thomas D.; Coccia, Peter F.; Edson, J. Roger; Nesbit, Mark E.; Krivit, William

doi:10.1002/1097-0142(19801001)46:7<1548::aid-cncr2820460709>3.0.co;2-7

Cited by 113 publications

(35 citation statements)

References 17 publications

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“…9,[16][17][18][19][20][21][22][23][24] Most FICH occurred soon after diagnosis, 27 within 7 days, and 13 patients presented with FICH at diagnosis. Because the median interval from FICH to death was 2 days, we estimate that 1.6% of patients with acute leukemia die from FICH without any opportunity for proper management.…”

Section: Discussionmentioning

confidence: 99%

Risk score model for fatal intracranial hemorrhage in acute leukemia

Kim

et al. 2006

Leukemia

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To build a risk score (RS) model of fatal intracranial hemorrhage (FICH) in patients with acute leukemia, we retrospectively assessed risk factors in 792 patients newly diagnosed with acute leukemia, 41 of whom had analyzable FICH. We found that female gender (relative risk (RR) ¼ 5.234, Po0.001), acute promyelocytic leukemia (RR ¼ 4.057, P ¼ 0.003), leukocytosis (RR ¼ 3.301, P ¼ 0.004), thrombocytopenia (RR ¼ 3.283, P ¼ 0.005) and prolonged prothrombin time (RR ¼ 3.291, P ¼ 0.016) were significantly associated with occurrence of FICH in multivariate analysis. To calculate RS for FICH, one point was assigned for each risk factor, making the RS between 0 and 5. The RS model segregated patients into three prognostic groups: a low-risk group (LRG) for RS of 0 or 1; an intermediate-risk group (IRG) for RS of 2 or 3; and a high-risk group (HRG) for RS of 4 or 5. Expectation of FICH was well correlated with risk groups (all P-values o0.001). Overall survival was significantly shorter in the HRG compared with the LRG. The RS model we constructed to predict the occurrence of FICH will be verified through prospective studies.

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Section: Discussionmentioning

confidence: 99%

Risk score model for fatal intracranial hemorrhage in acute leukemia

Kim

et al. 2006

Leukemia

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“…The National Institutes of Health Stroke Scale (NIHSS) was used to assess stroke severity at admission, 1 and was further divided into mild (0-6), moderate (7)(8)(9)(10)(11)(12)(13)(14), and severe (≥15) subgroups. Brain imaging on admission was performed for all patients either with CT or MRI.…”

Section: Online Supplementmentioning

confidence: 99%

“…7 Hormonal therapy and chemotherapy have been associated with an increased risk of cerebrovascular complications. 8,9 Cancer patients have a higher in-hospital poststroke mortality rate than those without cancer. 10 Cancer patients with cryptogenic stroke have higher D-dimer levels and more frequently infarcts located in multiple vascular territories than patients with stroke associated with other pathogenesis.…”

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confidence: 99%

Cancer in Young Adults With Ischemic Stroke

Aarnio

Joensuu

Haapaniemi

et al. 2015

Stroke

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Background and Purpose— Cancer is a risk factor for ischemic stroke. Little is known about cancer among young adults with ischemic stroke. We studied the frequency of cancer and its association with long-term risk of death among young patients with first-ever ischemic stroke. Methods— 1002 patients aged 15 to 49 years, registered in the Helsinki Young Stroke Registry, and with a median follow-up of 10.0 years (interquartile range 6.5–13.8) after stroke were included. Historical and follow-up data were derived from the Finnish Care Register and Statistics Finland. Survival between groups was compared with the Kaplan–Meier life-table method, and Cox proportional hazard models were used to identify factors associated with mortality. Results— One or more cancer diagnosis was made in 77 (7.7%) patients, of whom 39 (3.9%) had cancer diagnosed prestroke. During the poststroke follow-up, 41 (53.2%) of the cancer patients died. Median time from prestroke cancer to stroke was 4.9 (1.0–9.5) years and from stroke to poststroke cancer was 6.7 (2.7–10.9) years. Poststroke cancer was associated with age >40 years, heavy drinking, and cigarette smoking. The cumulative mortality was significantly higher among the cancer patients (68.6%, 95% confidence interval 52.0%–85.3%) compared with patients without cancer (19.7%, 95% confidence interval 16.3%–23.2%). Active cancer at index stroke, melanoma, and lung/respiratory tract cancer had the strongest independent association with death during the follow-up when adjusted for known poststroke mortality prognosticators. Conclusions— Cancer, and especially active cancer and no other apparent cause for stroke, is associated with unfavorable survival among young stroke patients.

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“…Toxicity is mostly due to the inhibition of protein synthesis and includes hypoalbuminemia, liver enzyme elevation, pancreatitis, hyperglycemia, thrombosis and hemorrhage [25][26][27][28]. Especially during the induction phase, when the drug is co-administered with steroids, ASNase related toxicity can necessitate the withdrawal of ASNase from treatment [29,30].…”

Section: Discussionmentioning

confidence: 99%

Five‐year single‐center study of asparaginase therapy within the ALL‐BFM 2000 trial

Schrey¹,

Speitel²,

Lanvers-Kaminsky³

et al. 2011

Pediatric Blood & Cancer

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BackgroundTherapeutic drug monitoring (TDM) of asparaginase (ASNase), a fundamental element of acute lymphoblastic leukemia treatment, was integrated in the ALL‐BFM 2000 protocol on a voluntary basis.MethodsOver a 5‐year period, 127 patients (1,355 samples) were monitored for asparaginase activity in a single‐center setting. We report monitoring data from throughout the ASNase containing treatment elements. Additional information obtained on risk stratification, minimal residual disease (MRD), steroid randomization and relapse is discussed in relation to ASNase activity.ResultsAt completion of the induction phase 93% (115/124) of patients showed sufficient ASNase activity (5,000 U/m2 Escherichia coli ASNase), 77 of 86 (90%) monitored patients finished the first re‐intensification element without requiring Erwinia ASNase. MRD, risk stratification and steroid randomization were not associated with significant differences in ASNase activity. Of patients who relapsed, only 25% (3/12) were able to maintain sufficient ASNase activity after E. coli ASNase.ConclusionThis single‐center data set gives a true and unbiased insight into clinical reality of ASNase therapy. It shows no significant relationship between MRD positivity or risk stratification and ASNase treatment intensity. Overall, within the ALL‐BFM 2000 trial, 90% of patients completed first re‐intensification without requiring third‐line Erwinia ASNase. Pediatr Blood Cancer 2011; 57: 378–384. © 2011 Wiley‐Liss, Inc.

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Thrombotic and hemorrhagic strokes complicating early therapy for childhood acute lymphoblastic leukemia

Cited by 113 publications

References 17 publications

Risk score model for fatal intracranial hemorrhage in acute leukemia

Risk score model for fatal intracranial hemorrhage in acute leukemia

Cancer in Young Adults With Ischemic Stroke

Five‐year single‐center study of asparaginase therapy within the ALL‐BFM 2000 trial

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