Details

Autor(en) / Beteiligte

• Rank, Cecilie Utke
• Toft, Nina
• Tuckuviene, Ruta
• Grell, Kathrine
• Nielsen, Ove Juul
• Frandsen, Thomas Leth
• Marquart, Hanne Vibeke Hansen
• Albertsen, Birgitte Klug
• Tedgård, Ulf
• Hallböök, Helene
• Ruud, Ellen
• Jarvis, Kirsten Brunsvig
• Quist-Paulsen, Petter
• Huttunen, Pasi
• Wartiovaara-Kautto, Ulla
• Jónsson, Ólafur Gísli
• Trakymiene, Sonata Saulyte
• Griškevičius, Laimonas
• Saks, Kadri
• Punab, Mari
• Schmiegelow, Kjeld

Titel

Thromboembolism in acute lymphoblastic leukemia: results of NOPHO ALL2008 protocol treatment in patients aged 1 to 45 years

Ist Teil von

• Blood, 2018-05, Vol.131 (22), p.2475-2484

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2018

Link zum Volltext

Quelle

Free E-Journal (出版社公開部分のみ）

Beschreibungen/Notizen

• Thromboembolism frequently occurs during acute lymphoblastic leukemia (ALL) therapy. We prospectively registered thromboembolic events during the treatment of 1772 consecutive Nordic/Baltic patients with ALL aged 1 to 45 years who were treated according to the Nordic Society of Pediatric Hematology and Oncology ALL2008 protocol (July 2008-April 2017). The 2.5-year cumulative incidence of thromboembolism (N = 137) was 7.9% (95% confidence interval [CI], 6.6-9.1); it was higher in patients aged at least 10 years (P < .0001). Adjusted hazard ratios (HRas) were associated with greater age (range, 10.0-17.9 years: HRa, 4.9 [95% CI, 3.1-7.8; P < .0001]; 18.0-45.9 years: HRa, 6.06 [95% CI, 3.65-10.1; P < .0001]) and mediastinal mass at ALL diagnosis (HRa, 2.1; 95% CI, 1.0-4.3; P = .04). In a multiple absolute risk regression model addressing 3 thromboembolism risk factors, age at least 10 years had the largest absolute risk ratio (RRage, 4.7 [95% CI, 3.1-7.1]; RRenlarged lymph nodes, 2.0 [95% CI, 1.2-3.1]; RRmediastinal mass, 1.6 [95% CI, 1.0-2.6]). Patients aged 18.0 to 45.9 years had an increased hazard of pulmonary embolism (HRa, 11.6; 95% CI, 4.02-33.7; P < .0001), and patients aged 10.0 to 17.9 years had an increased hazard of cerebral sinus venous thrombosis (HRa, 3.3; 95% CI, 1.5-7.3; P = .003) compared with children younger than 10.0 years. Asparaginase was truncated in 38/128 patients with thromboembolism, whereas thromboembolism diagnosis was unassociated with increased hazard of relapse (P = .6). Five deaths were attributable to thromboembolism, and patients younger than 18.0 years with thromboembolism had increased hazard of dying compared with same-aged patients without thromboembolism (both P ≤ .01). In conclusion, patients aged at least 10 years could be candidates for preemptive antithrombotic prophylaxis. However, the predictive value of age 10 years or older, enlarged lymph nodes, and mediastinal mass remain to be validated in another cohort. •Thromboembolism is a frequent treatment-related complication in ALL patients aged 1 to 45 years, with a cumulative incidence of 7.9%.•Patients aged ≥10 years are at highest risk during asparaginase treatment, and may be candidates for preemptive antithrombotic prophylaxis. [Display omitted]