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.
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Childrens Med Res Inst, Westmead, NSW, Australia
Lady Cilento Childrens Hosp, Dept Haematol, Brisbane, Qld, AustraliaSydney Childrens Hosp, Kids Canc Ctr, Randwick, NSW, Australia
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Ankara Etlik Zubeyde Hanim Womens & Maternal Trai, Newborn Unit, Ankara, TurkeyAnkara Etlik Zubeyde Hanim Womens & Maternal Trai, Newborn Unit, Ankara, Turkey
Sivaslioglu, Selda
Gursel, Turkiz
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Gazi Univ, Pediat Hematol Unit, Dept Pediat, Sch Med, Ankara, TurkeyAnkara Etlik Zubeyde Hanim Womens & Maternal Trai, Newborn Unit, Ankara, Turkey
Gursel, Turkiz
Kocak, Ulker
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Gazi Univ, Pediat Hematol Unit, Dept Pediat, Sch Med, Ankara, TurkeyAnkara Etlik Zubeyde Hanim Womens & Maternal Trai, Newborn Unit, Ankara, Turkey
Kocak, Ulker
Kaya, Zuhre
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Gazi Univ, Pediat Hematol Unit, Dept Pediat, Sch Med, Ankara, TurkeyAnkara Etlik Zubeyde Hanim Womens & Maternal Trai, Newborn Unit, Ankara, Turkey