Open AccessVenous thromboembolism in a large cohort of children with acute lymphoblastic leukemia: Risk factors and effect on prognosis
Author(s) -
Klaassen Irene L. M.,
Lauw Mandy N.,
Fiocco Marta,
Sluis Inge M.,
Pieters Rob,
Middeldorp Saskia,
Wetering Marianne D.,
GrootKruseman Hester A.,
Ommen C. Heleen
Publication year - 2019
Publication title -
research and practice in thrombosis and haemostasis
Language(s) - English
Resource type - Journals
ISSN - 2475-0379
DOI - 10.1002/rth2.12182
Subject(s) - medicine , cohort , asparaginase , logistic regression , regimen , pediatrics , venous thromboembolism , proportional hazards model , venous thrombosis , thrombosis , acute leukemia , lymphoblastic leukemia , leukemia
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.