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The frequency and management of asparaginase‐related thrombosis in paediatric and adult patients with acute lymphoblastic leukaemia treated on Dana‐Farber Cancer Institute consortium protocols
Author(s) -
Grace Rachael F.,
Dahlberg Suzanne E.,
Neuberg Donna,
Sallan Stephen E.,
Connors Jean M.,
Neufeld Ellis J.,
DeAngelo Daniel J.,
Silverman Lewis B.
Publication year - 2011
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.2010.08524.x
Subject(s) - medicine , asparaginase , thrombosis , pediatrics , venous thromboembolism , low molecular weight heparin , cancer , lymphoblastic leukemia , venous thrombosis , heparin , surgery , leukemia
Summary The optimal management of asparaginase‐associated thrombotic complications is not well‐defined. We report the features, management and outcome of paediatric (ages 0–18 years) and adult (18–50 years) patients with acute lymphoblastic leukaemia (ALL) with asparaginase‐related venous thromboembolic events (VTE) treated at Dana‐Farber Cancer Institute on clinical trials for newly diagnosed ALL between 1991–2008. Of 548 patients, 43 (8%) had VTE, including 27/501 (5%) paediatric and 16/47 (34%) adult patients. Sinus venous thrombosis occurred in 1·6% of patients. Age was the only significant predictor of VTE, with those aged >30 years at very high risk (VTE rate 42%). 74% of patients received low molecular weight heparin after VTE. Complications of anticoagulation included epistaxis (9%), bruising (2%) and, in two adult patients, major bleeding. Thirty patients (70%) ultimately received at least 85% of the intended doses of asparaginase. 33% of patients experienced recurrent VTE (paediatric 17% vs. adults 47%, P = 0·07). The 48‐month event‐free survival for patients with VTE was 85 ± 6% compared with 88 ± 2% for those without VTE ( P = 0·36). This study confirms that, after VTE, asparaginase can be restarted with closely monitored anticoagulation after imaging demonstrates clot stabilization or improvement. With this management strategy, a history of VTE does not appear to adversely impact prognosis.