Cerebral sinus venous thrombosis during childhood acute lymphoblastic leukemia therapy: Risk factors and management

被引:34
|
作者
Ghanem, KhaledM. [1 ]
Dhayni, Raghida M. [1 ]
Al-Aridi, Carol [1 ]
Tarek, Nidale [1 ]
Tamim, Hani [2 ]
Chan, Anthony K. C. [3 ]
Saab, Raya [1 ]
Abboud, Miguel R. [1 ]
El-Solh, Hassan [1 ]
Muwakkit, Samar A. [1 ]
机构
[1] Amer Univ Beirut, Dept Pediat & Adolescent Med, Hematol Oncol Serv, Childrens Canc Ctr Lebanon, Beirut, Lebanon
[2] Amer Univ Beirut, Dept Internal Med, Beirut, Lebanon
[3] McMaster Univ, Thrombosis & Atherosclerosis Res Inst, Dept Pediat, Hamilton, ON, Canada
关键词
asparaginase; cerebral sinus venous thrombosis; childhood ALL; steroids; PROTHROMBIN G20210A; CHILDREN; ASPARAGINASE; THROMBOEMBOLISM; THROMBOPHILIA; MULTICENTER; PREVALENCE; ONCOLOGY; LEBANON; EVENTS;
D O I
10.1002/pbc.26694
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Cerebral sinus venous thrombosis (CSVT) is a rare but serious complication of childhood acute lymphoblastic leukemia (ALL) therapy. No available consensus exists regarding its risk factors and appropriate management due to the rarity of cases. Procedures: Out of 209 ALL patients aged 1-21 years treated at the Children's Cancer Center of Lebanon between May 2002 and May 2015, 13 developed CSVT during therapy. Patient characteristics, clinical management, and outcomes were studied. Results: The incidence of CSVT was 6.2% (95% confidence interval [CI]: 3.4-10.4). Using univariate analysis, increased risk of CSVT was observed with age > 10 years (odds ratio [OR]: 3.56, 95% CI: 1.13-11.2), T-cell immunophenotype (OR: 4.14, 95% CI: 1.16-14.7), and intermediate/high risk disease (OR: 3.4, 95% CI: 1.03-11.7). The only statistically significant risk factor by multivariate analysis was the treatment as per the intermediate-/high-risk protocol (HR: 15.6, 95% CI: 1.43-171.3). Most cases (77%) occurred in the postinduction phases of treatment while receiving a combination of asparaginase and dexamethasone rather than prednisone. Treatment with low molecular weight heparin (LMWH) for a minimum of 3 months and until significant radiological improvement is observed resulted in 100% survival rate. All but one patient had complete neurological recovery. Conclusions: CSVT is an important complication of childhood ALL therapy. Postinduction combined asparaginase and dexamethasone intensive treatment for intermediate-/high-risk patients was the most important risk factor. Treatment with LMWH for a minimum of 3 months, and until asparginase therapy is over, with major radiological improvement seems to be effective and feasible.
引用
收藏
页数:6
相关论文
共 50 条
  • [1] Treatment-induced cerebral sinus venous thrombosis in childhood acute lymphoblastic malignancies: New risk factors to consider
    El-Khoury, Habib
    Saifi, Omran
    Haddad, Salame
    Chahrour, Mohamad
    Ghanem, Khaled M.
    Mubarak, Yaacoub
    Tamim, Hani
    Makki, Maha
    Zakka, Cyril
    Chan, Anthony K.
    Mahfouz, Rami
    Tarek, Nidale
    El-Solh, Hassan
    Abboud, Miguel R.
    Saab, Raya
    Muwakkit, Samar A.
    PEDIATRIC BLOOD & CANCER, 2021, 68 (11)
  • [2] Cerebral sinus venous thrombosis in indian pediatric patients with acute lymphoblastic leukemia: Incidence, risk factors, and outcome
    Garg, Akanksha
    Kashyap, Rajesh
    Lal, Hira
    Mishra, Prabhakar
    INDIAN JOURNAL OF MEDICAL AND PAEDIATRIC ONCOLOGY, 2020, 41 (04) : 523 - 529
  • [3] Risk factors for symptomatic venous thromboembolism during therapy for childhood acute lymphoblastic leukemia
    Mateos, M. K.
    Trahair, T. N.
    Mayoh, C.
    Barbaro, P. M.
    Sutton, R.
    Revesz, T.
    Barbaric, D.
    Giles, J. E.
    Alvaro, F.
    Mechinaud, F.
    Catchpoole, D.
    Kotecha, R. S.
    Dalla-Pozza, L.
    Quinn, C. J.
    MacGregor, S.
    Chenevix-Trench, G.
    Marshall, G. M.
    THROMBOSIS RESEARCH, 2019, 178 : 132 - 138
  • [4] Incidence and Risk Factors for Hypertension During Childhood Acute Lymphoblastic Leukemia Therapy
    Malhotra, Payal
    Kapoor, Gauri
    Jain, Sandeep
    Garg, Bhawna
    INDIAN PEDIATRICS, 2018, 55 (10) : 877 - 879
  • [5] Clinical Course of Cerebral Venous Thrombosis in Adult Acute Lymphoblastic Leukemia
    Zuurbier, Susanna M.
    Lauw, Mandy N.
    Coutinho, Jonathan M.
    Majoie, Charles B. L. M.
    van der Holt, Bronno
    Cornelissen, Jan J.
    Middeldorp, Saskia
    Biemond, Bart J.
    Stam, Jan
    JOURNAL OF STROKE & CEREBROVASCULAR DISEASES, 2015, 24 (07) : 1679 - 1684
  • [6] Case Report: A successful outcome of nadroparin calcium therapy for cerebral venous sinus thrombosis in a child with acute lymphoblastic leukemia
    Xie, Lichun
    Xu, Ye
    Zhou, Guichi
    Chen, Fen
    Li, Changgang
    Ma, Lian
    Wen, Feiqiu
    FRONTIERS IN PEDIATRICS, 2024, 12
  • [7] The Risk Factors for Thrombosis in Children With Acute Lymphoblastic Leukemia
    Sivaslioglu, Selda
    Gursel, Turkiz
    Kocak, Ulker
    Kaya, Zuhre
    CLINICAL AND APPLIED THROMBOSIS-HEMOSTASIS, 2014, 20 (06) : 651 - 653
  • [8] Acquired and Congenital Risk Factors associated with Cerebral Venous Sinus Thrombosis
    McBane, Robert D., II
    Tafur, Alfonso
    Wysokinski, Waldemar E.
    THROMBOSIS RESEARCH, 2010, 126 (02) : 81 - 87
  • [9] Thrombosis in children with acute lymphoblastic leukemia. Part II. Pathogenesis of thrombosis in children with acute lymphoblastic leukemia: effects of the disease and therapy
    Athale, UH
    Chan, AKC
    THROMBOSIS RESEARCH, 2003, 111 (4-5) : 199 - 212
  • [10] Cerebral Sinus Venous Thrombosis in Pediatric Acute Lymphoblastic Leukemia: Incidence, Clinical Characteristics, and Long-term Neurologic Outcomes
    Johnson-Bishop, Lindsay
    Karakas, Cemal
    Kralik, Stephen F.
    Cohen, Clay T.
    Zobeck, Mark
    Park, Nick
    Rabin, Karen
    Pehlivan, Davut
    Bhar, Saleh
    JOURNAL OF CHILD NEUROLOGY, 2024, 39 (13-14) : 494 - 499