scholarly journals Prevention of Venous Thrombotic Events in Adult Patients with Acute Lymphoblastic Leukemia Treated in a Pediatric-Inspired Protocol - a Graall Study

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2776-2776 ◽  
Author(s):  
Corentin Orvain ◽  
Marie Balsat ◽  
Véronique Lhéritier ◽  
Emmanuelle Tavernier ◽  
Jean-Pierre Marolleau ◽  
...  
Keyword(s):  
Platelet Count ◽  
Acute Lymphoblastic Leukemia ◽  
Induction Therapy ◽  
Lymphoblastic Leukemia ◽  
Adult Patients ◽  
E Coli ◽  
Intravenous Injections ◽  
Increased Risk ◽  
Consolidation Phase ◽  
To Receive

Abstract Background: Patients undergoing treatment for acute lymphoblastic leukemia (ALL) are at risk for thrombosis, in part due to the use of L-asparaginase (L-ASP) and subsequent antithrombine (AT) deficiency. Previous reports showed that patients with venous thrombotic events (VTE) have a lower event-free survival that may be due to early discontinuation of L-ASP. It has been suggested that AT replacement could decrease the rate of thrombosis and prevent L-ASP discontinuation. We report herein the results of the prophylactic replacement strategy in the pediatric-inspired prospective GRAALL-2005 study. Methods: All patients received a 5-drug induction therapy with 8 native E. Coli-ASP intravenous injections (6,000 UI/m2/injection). Patients in complete remission (CR) received two consolidation courses each containing two L-ASP intravenous injections (10000 UI/m2/injection). All patients in persistent CR for whom allogeneic stem cell transplantation was not indicated in first CR received a late intensification with the same drugs as in the induction course, followed by the repetition of one consolidation course. Platelet transfusion support was recommended for platelets below 20 x 109/L, fresh frozen plasma (FFP) or fibrinogen concentrates were recommended if fibrinogen levels fell below 0.5 g/L, and AT concentrate substitution therapy was recommended in order to maintain AT levels above 60%. Prophylactic heparin was recommended during induction and late intensification. All cases of VTE were identified prospectively by clinical signs and confirmed by radiological imaging based on institutional guidelines. Results: Between 2006 and 2014, 787 adult patients with newly diagnosed Philadelphia-negative ALL were included. The incidence rate of VTE was 14.4% (113 VTEs in 110 patients). VTEs included 72 (64%) deep vein thromboses (DVT), with one third in the lower limb and two thirds in the upper limb, 32 (28%) cerebral venous thrombosis (CVT), and 13 (12%) pulmonary embolism (PE). No disease characteristic was associated with a higher risk of thrombosis. Patients with DVT and/or PE were older (median age of 40 versus 38 for those with CVT versus 35 for those without VTE, p=0.04), had a higher BMI (median BMI of 26 versus 23 for those with CVT and 24 for those without VTE, p=0.01), and had a higher platelet count at diagnosis (median platelet count of 100 G/l versus 84 G/l for those with CVT versus 68 G/l for those without VTE, p=0.06) whereas patients with CVT had higher hemoglobin levels (median hemoglobin level of 11.7 g/dl versus 10.1 g/dl for those with DVT/PE versus 10.2 g/dl for those without VTE, p=0.03). Sixty-seven percent of VTEs occurred during induction therapy. Other VTEs occurred as follows: 17 (15%) during consolidation phase 1 (688 patients), 4 (4%) during consolidation phase 2 (537 patients), 9 (8%) during late intensification (356 patients), and 7 (6%) in 335 during consolidation phase 3 (335 patients). The type of thrombosis was different according to treatment phase as most CVT occurred during induction therapy (29 versus 3 CVTs during subsequent phases of treatment, p=0.003). During induction therapy, patients with VTE were more likely to have received heparin prophylaxis (82% versus 60% for those without VTE, odds ratio (OR) 1.8, p=0.06) and fibrinogen prophylaxis (14% versus 8% for those without VTE, OR 2, p=0.05) whereas they received less AT prophylaxis (82% versus 88% for those without VTE, OR 0.5, p=0.05). Patients with VTE received less L-ASP infusions during induction therapy (median number of 7 versus 8 injections for those without VTE, p<0.001) and they were less likely to receive L-ASP during late intensification (64% versus 69% for those without TVE during induction and who went on to receive late intensification, p<0.001). Among 25 patients who experienced VTE during induction and in whom L-ASP, either native E. Coli-ASP or Erwiniase-ASP, was reintroduced during late intensification, none presented with recurrence of VTE. Conclusion: In ALL patients receiving L-ASP therapy, appropriate AT prophylaxis was associated with less VTE and should be used extensively. Maintaining higher AT levels in patients at increased risk for VTE should be evaluated. L-ASP can be reintroduced in patients who experienced VTE during induction as none had thrombotic recurrence. Fibrinogen concentrates may increase the risk of thrombosis and should be restricted to patients with hemorrhage. Disclosures Dombret: Amgen: Consultancy, Honoraria, Research Funding, Speakers Bureau.

scholarly journals Thromboembolism Prophylaxis in Adult Patients with Acute Lymphoblastic Leukemia Treated in the GRAALL-2005 Study

Blood ◽  
2020 ◽  
Author(s):  
Corentin Orvain ◽  
Marie Balsat ◽  
Emmanuelle Tavernier ◽  
Jean-Pierre Marolleau ◽  
Thomas Pabst ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Fresh Frozen Plasma ◽  
Adult Patients ◽  
Bleeding Complications ◽  
Thromboembolism Prophylaxis ◽  
Prophylactic Measures ◽  
Increased Risk ◽  
Fresh Frozen ◽  
Grade 3

Patients undergoing treatment for acute lymphoblastic leukemia (ALL) are at risk for thrombosis, in part due to the use of L-asparaginase (L-ASP). Antithrombin (AT) replacement has been suggested to prevent VTE and thus might increase exposure to ASP. We report herein the results of the prophylactic replacement strategy in the pediatric-inspired prospective GRAALL-2005 study. Between 2006 and 2014, 784 adult patients with newly diagnosed Philadelphia-negative ALL were included. The incidence rate of VTE was 16% with 69% of them occurring during induction therapy. Most patients received AT supplementation (87%). After excluding patients who did not receive L-ASP or developed thrombosis before L-ASP, AT supplementation did not have a significant impact on VTE (8% versus 14%, OR: 0.6, p=0.1). Fibrinogen concentrates administration was associated with an increased risk of VTE (17% versus 9%, OR 2.2, p=0.02) whereas transfusion of fresh-frozen plasma had no effect. Heparin prophylaxis was associated with an increased risk of VTE (13% versus 7%, OR 1.9, p=0.04). Prophylactic measures were not associated with an increased risk of grade 3-4 bleeding complications. The rate of VTE recurrence after L-ASP reintroduction was 3% (1/34). In ALL patients receiving L-ASP therapy, the use of fibrinogen concentrates may increase the risk of thrombosis and should be restricted to rare patients with hypofibrinogenemia-induced hemorrhage. Patients developed VTE despite extensive AT supplementation which advocates for additional prophylactic measures. While this large descriptive study was not powered to demonstrate the efficacy of these prophylactic measures, it provides important insight to guide future trial design. NCT00327678.

scholarly journals Obesity is associated with residual leukemia following induction therapy for childhood B-precursor acute lymphoblastic leukemia

Blood ◽  
2014 ◽  
Vol 124 (26) ◽  
pp. 3932-3938 ◽  
Author(s):  
Etan Orgel ◽  
Jonathan Tucci ◽  
Waseem Alhushki ◽  
Jemily Malvar ◽  
Richard Sposto ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Minimal Residual Disease ◽  
Induction Therapy ◽  
Residual Disease ◽  
Lymphoblastic Leukemia ◽  
Increased Risk ◽  
Key Points ◽  
Minimal Residual

Key Points Obesity is associated with increased risk for persistent minimal residual disease after induction therapy for pediatric BP-ALL.

scholarly journals Risk Factors for Induction Related Mortality in Adults Patients with Acute Lymphoblastic Leukemia: Report from a Hispanic Population

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5162-5162
Author(s):  
Sergio I Inclan-Alarcon ◽  
Christianne Bourlon ◽  
Oscar Manuel Fierro-Angulo ◽  
Jesus A Garcia-Ramos ◽  
Santiago Riviello-Goya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Prognostic Score ◽  
Univariate Analysis ◽  
Adult Patients ◽  
Hispanic Population ◽  
Increased Risk ◽  
The Impact ◽  
Hispanic Adult

Abstract Introduction Acute lymphoblastic leukemia (ALL) represents 20-30% of acute leukemia in adults. Higher incidence and inferior outcomes in Hispanic population have been described. In Latin Americans induction mortality (IM) is a major cause of death representing 20-50% vs.7-11% in developed countries. Our aim was to determine risk factors (RF) related to IM in ALL Hispanic adult patients. Methods We retrospectively analyzed clinical data of ≥18yo patients with ALL diagnosed and treated at our institution within 2009 and 2016. Results A total of 170 patients were included. Median age was 29 years (16-70), 64% were AYA, 96.8% had B-cell ALL, and 62.3% received Hyper-CVAD. IM rate was 13.4%. In 64.1% IM was related to an infectious cause. The most frequent infection was pneumonia (39.8%). Gram-negative etiology was more prevalent (35.5% vs. 10.2%), however, IM rate was higher in gram-positive infections (26.3% vs .13.6%; p=.028). RF related to IM in univariate analysis were: CNS involvement (OR4.6,95%IC2.8-9.5;p=<.001), tumor lysis syndrome (TLS) (OR 5.6, 95% CI 2.2-14.1; p=<.001), need for dialysis (OR 28.9, 95% CI 5.3-157.1; p=<.001), primary hypertension (OR 3.5, 95% CI 1.0-12.7; p=.052), shock status (OR 10.3, 95% CI 3.9-27.3; p=<.001), ECOG³2 (OR 1.9, 95% IC 1.1-3.4; p=.022), T-ALL (OR 2.2, 95% IC 1.1-4.3; p=.026), Hyper-CVAD (OR 1.9, 95% IC 1.1-3.8; p=0.51), ventilation assistance (OR 7.7, 95% IC 2.8-21; p=<.001), and vasopressor use (OR 7.6, 95% IC 2.8-20.6; p=<.001). In multivariate analysis TLS, need for dialysis and shock, kept statistical significance. Conclusions To our knowledge, this is the largest study that evaluates the impact over IM of biological, social, and economic factors in Hispanic adult patients with ALL. We identified factors not previously described such as hypertension and need for dialysis. Multicenter prospective studies most be urged to asses and validate these RF, and design a bedside prognostic score that can predict an increased risk of IM at ALL diagnosis. Disclosures No relevant conflicts of interest to declare.

Residual disease at the end of induction therapy as a predictor of relapse during therapy in childhood B-lineage acute lymphoblastic leukemia.

1992 ◽  
Vol 10 (12) ◽  
pp. 1879-1888 ◽  
Author(s):  
R Wasserman ◽  
N Galili ◽  
Y Ito ◽  
J H Silber ◽  
B A Reichard ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Induction Therapy ◽  
Clinical Remission ◽  
Residual Disease ◽  
Lymphoblastic Leukemia ◽  
Leukemia Cells ◽  
Induction Phase ◽  
Increased Risk ◽  
B Lineage ◽  
Wbc Count

PURPOSE More than 95% of children with B-lineage acute lymphoblastic leukemia (ALL) achieve a clinical remission after the induction phase of chemotherapy (first 28 days) as evaluated by morphologic criteria. However, relapse occurs in approximately 30% of these children. The objective of this study was to determine whether the outcome of patients in clinical remission at the end of induction therapy could be predicted using a highly sensitive method to detect residual disease. PATIENTS AND METHODS All children diagnosed with B-lineage ALL at the Children's Hospital of Philadelphia during a 2-year period were eligible. The extent of residual leukemia was quantitated in remission marrow samples obtained at the end of induction therapy in 44 children using a phage clonogenic assay in association with complementarity-determining-region 3 (CDR3)-polymerase chain reaction (PCR). RESULTS Residual disease was a significant predictor of outcome independent of WBC count, age, or sex. The estimated relapse-free survival (RFS) during therapy was 50.4% (+/- 12.6%) for patients with high residual disease (> or = 0.6% leukemia cells among total marrow B cells) versus 91.9% (+/- 5.5%) for those with lower levels (P < .002). There were no significant differences in off-treatment RFS between patients with high or low residual disease who completed therapy in continuous remission (P = .82). The overall estimated RFS was 32.3% (+/- 11.6%) for patients with high residual disease versus 62.6% (+/- 10.7%) for patients with lower levels of residual leukemia cells, with a median follow-up of 5.3 years for patients in continuous remission (P < .008). CONCLUSION PCR detection of high residual disease at the end of induction therapy identifies patients at increased risk for relapse during therapy.

Asparaginase-Associated Myelosuppression and Effects on Dosing of Other Chemotherapeutic Agents In Children and Adolescents with Acute Lymphoblastic Leukemia

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3249-3249
Author(s):  
Reid Merryman ◽  
William J. Gostic ◽  
Kristen E. Stevenson ◽  
Donna Neuberg ◽  
Jane O'Brien ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Residual Disease ◽  
Lymphoblastic Leukemia ◽  
Chemotherapeutic Agents ◽  
E Coli ◽  
Starting Dose ◽  
Consolidation Phase ◽  
Two Phases ◽  
Dose Modifications ◽  
Induced Changes

Abstract Abstract 3249 Background: L-asparaginase (ASP) is a universal component of treatment for childhood acute lymphoblastic leukemia (ALL). It is associated with multiple toxicities, including allergy, pancreatitis, and thrombosis. It is not thought to have a significant direct myelosuppressive effect, but its impact on the ability to tolerate other chemotherapeutic agents has not been well-characterized. Patients and Methods: Between 2005–2010, 61 patients (pts) were diagnosed with Standard Risk (SR) ALL at DFCI/Children's Hospital Boston and treated on DFCI ALL Consortium Protocol 05-01. SR pts met all of the following criteria: 1 to <10 years of age; highest pretreatment WBC < 50,000/mm3; absence of central nervous system leukemia (ie, CNS-1 or -2, only); absence of T-cell markers; absence of t(9;22), MLL gene rearrangements, and hypodiploidy; and low minimal residual disease (MRD) levels at the end of the first 4 weeks of treatment. Beginning at week 7, all SR pts began a 30-week (wk) Consolidation phase, consisting of every 21-day cycles of vincristine (day 1), dexamethasone (days 1–5), 6-mercaptopurine (6MP) (days 1–14), and methotrexate (MTX) (days 1, 8 and 15), and also including 30 consecutive wks of ASP (either weekly IM E.coli ASP 25000 IU/m2 or every 2-wk IV PEG ASP 2500 IU/m2). The Continuation phase followed Consolidation, and consisted of identical systemic and intrathecal (IT) chemotherapy, except without any ASP. Starting dose of 6MP was 50 mg/m2/day and of MTX was 30 mg/m2/dose. Doses were adjusted every 21 days to maintain absolute phagocyte (APC) nadirs > 500/mm3 and platelet nadirs > 75,000. Chemotherapy cycles were delayed until APC was ≥ 1000/mm3 or platelets were ≥ 100,000. Medical records of the 61 SR pts were reviewed to ascertain the dose modifications of MTX and 6MP made due to low or high blood counts (APC and/or platelets) and/or delays in starting cycles (defined as ≥25 day interval between cycles). 27 pts were randomized to receive IM E. coli ASP, 29 to IV PEG ASP, and 5 declined randomization (directly assigned to IM E.coli ASP). A total of 1780 chemotherapy cycles were evaluated longitudinally using generalized estimating equations, 498 during Consolidation (with ASP) and 1282 during Continuation (No ASP). Results: Median age was 3.9 years and 57% of pts were female. There was a higher proportion of cycles modified for low blood counts (ie, dose reduction of MTX and/or 6MP) during Consolidation (ASP given) compared to Continuation (No ASP) (24% vs 8%, Odds Ratio (OR) = 2.35 [95% CI 1.41, 3.94]; p < 0.01). There was a lower proportion of cycles modified due to high blood counts (ie, dose escalation of MTX and/or 6MP) during Consolidation (ASP given) compared to Continuation (No ASP) (20% vs 33%, OR =0.20 [95% CI 0.13, 0.30]; p < 0.01). Figures 1 and 2 summarize the dosing of MTX and 6-MP during Consolidation and Continuation. During Consolidation, the proportion of cycles in which pts received escalated doses of MTX (above the starting dose) was 21% compared to 62% during Continuation. Similarly, the proportion of cycles in which pts received escalated doses of 6-MP (above starting dose) was 10% in Consolidation compared to 59% in Continuation. 17% of Consolidation cycles were delayed because starting criteria were not met compared to 9% of Continuation cycles when pts were not receiving ASP (OR =2.08, 95% CI 1.18, 3.64; p=0.01). No difference in delays or dose modification for counts was detected between ASP randomization arms in either the Consolidation or Continuation phases. Conclusion: During Consolidation, when SR pts received ASP, blood counts were lower than during Continuation (no ASP), despite an otherwise identical schedule of other systemic and IT agents during these two phases. Because of low blood counts, pts received lower doses of MTX and 6MP when they were also receiving ASP, and delays in beginning chemotherapy cycles were more common. This suggests that ASP has a myelosuppressive effect, either direct (due to ASP) or secondary to ASP-induced changes in the levels or metabolism of other chemotherapeutic agents; further investigation is necessary to elucidate the precise mechanism. The myelosuppressive effect of ASP should be taken into consideration when designing regimens for pts with ALL which combine ASP with other agents to avoid excessive dose reductions and/or treatment delays. Disclosures: Sallan: Enzon Inc.: Honoraria, Research Funding. Silverman:EUSA Pharmaceuticals: Consultancy, Honoraria; Enzon Pharmaceuticals: Consultancy, Honoraria.

Long-Term Results Of Allogeneic Stem Cell Transplantation In 56 Adult Patients With Philadelphia-Positive Acute Lymphoblastic Leukemia: A 20-Year Single Center Experience

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5521-5521
Author(s):  
Adalberto Ibatici ◽  
Fabio Guolo ◽  
Federica Galaverna ◽  
Clara Delle Piane ◽  
Alida Dominietto ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Retrospective Analysis ◽  
Induction Therapy ◽  
Lymphoblastic Leukemia ◽  
Adult Patients ◽  
Long Term Results ◽  
Prognostic Impact ◽  
Single Center ◽  
Single Center Experience

Abstract Background Despite the great clinical benefit from the advent of tyrosine-kinase inhibitors (TKIs) treatment for adult patients with Philadelphia-positive acute lymphoblastic leukemia (Ph+ ALL), allogeneic hematopoietic stem cells transplantation (allo-HSCT) does not appear to be dispensable, if the optimal long-term outcome is to be achieved. However, there are only few data reported on long-term survivors with Ph+ ALL, particularly for those not receiving pre-transplant TKIs in the conventional induction therapy. In this retrospective analysis, we report on the long term outcomes of myeloablative allo-HSCT during the past 2 decades as single center experience. Data on the use of post-transplant TKIs and molecular monitoring for minimal residual disease are being collected to investigate their predictive role. Patients and methods Between 1989 and 2013, we collected 56 patients who underwent myeloablative allo-HSCT from HLA-identical siblings (n: 24), unrelated donors (n: 17), alternative donors (n: 15). Median age was 41 years (16-64). Disease phase at transplant was CR1 in 30 pts (53%), >CR1 in 26 pts. Pre-transplant TKI as part of induction therapy was given in 25 pts (44%). Conditioning regimen was TBI-based in 47 pts (83%) and chemotherapy-based in 9 pts. GVHD prophylaxis was given according to Center standard practice. Results Median follow-up was 67 months (1- 244). There were no cases of primary graft failure. Incidence of grade II-IV acute GVHD occurred in 31 pts (55%) and extensive chronic GVHD in 18 pts (32%). Transplant-related mortality was 35% at 2 years and 7 more patients died of non-relapse causes up to 12 years after transplant. The 10-year OS was 25% and significantly better for patients in CR1 vs. >CR1 (36% VS 14% - p=0,006). The 10-year DFS was 27% with no statistical difference for pts in CR1 vs. >CR1. Age at transplant and pre-transplant TKI did not affect the outcomes. Conclusions In this retrospective analysis over a 20-year time period, we show that approximately one-third of adult Ph+ ALL are cured if they undergo allo-HSCT in CR1. Therefore, we confirm that disease status at transplant has a major prognostic impact on clinical outcomes. The apparent lack of benefit of pre-transplant TKI exposure may be due to the retrospective nature of the analysis. Disclosures: No relevant conflicts of interest to declare.

Response of children with high-risk acute lymphoblastic leukemia treated with and without cranial irradiation: a report from the Children's Cancer Group.

1998 ◽  
Vol 16 (3) ◽  
pp. 920-930 ◽  
Author(s):  
J Nachman ◽  
H N Sather ◽  
J M Cherlow ◽  
M G Sensel ◽  
P S Gaynon ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
High Risk ◽  
Induction Therapy ◽  
Lymphoblastic Leukemia ◽  
Early Response ◽  
Cranial Irradiation ◽  
Cancer Group ◽  
Pediatric All ◽  
Wbc Count ◽  
To Receive

PURPOSE Intensified intrathecal (i.t.) chemotherapy without cranial radiation therapy (CRT) prevents CNS relapse in children with low-risk and intermediate-risk acute lymphoblastic leukemia (ALL). In the current study, high-risk ALL patients who achieved a rapid early response (RER) to induction chemotherapy were randomized to receive intensive systemic chemotherapy and presymptomatic CNS therapy that consisted of either i.t. methotrexate (MTX) and CRT or intensified i.t. MTX alone. PATIENTS AND METHODS Children (n = 636) with high-risk ALL (aged 1 to 9 years and WBC count > or = 50,000/microL or age > or = 10 years, excluding those with lymphomatous features) who achieved an RER (< or = 25% marrow blasts on day 7) to induction therapy and lacked CNS disease at diagnosis were randomized to receive systemic therapy with either i.t. MTX and CRT (regimen A, n = 317) or intensified i.t. MTX alone (regimen B, n = 319). RESULTS Interim analysis in July 1993 revealed 3-year event-free survival (EFS) estimates of 82.1% +/- 4.0% (SD)and 70.4% +/- 4.2% for patients treated on regimens A and B, respectively (P = .004). As of January 1996, outcome had changed: 5-year EFS estimates were 69.1% +/- 3.4% and 75.0% +/- 2.7% for regimens A and B, respectively (P = 0.50). Marrow relapses comprised 57 events on regimen A and 43 events on regimen B. Fewer late events occurred on regimen B. CONCLUSION For high-risk pediatric ALL patients who show an RER to induction therapy and are treated with systemic Children's Cancer Group (CCG)-modified Berlin-Frankfurt-Munster (BFM) chemotherapy, presymptomatic CNS therapy that consists of either i.t. MTX plus CRT or intensified i.t. MTX alone results in a similar 5-year EFS outcome. Furthermore, intensified i.t. MTX may protect against late bone marrow relapse.

scholarly journals Anticoagulation treatment and prophylactic edoxaban for cerebral sinus venous thrombosis in an adolescent with acute lymphoblastic leukemia

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110132
Author(s):  
Masaya Koganesawa ◽  
Ryosuke Matsuno ◽  
Yumiko Sugishita ◽  
Ryota Kaneko ◽  
Naoko Kawabata ◽  
...  
Keyword(s):  
Young Adults ◽  
Acute Lymphoblastic Leukemia ◽  
Venous Thrombosis ◽  
Induction Therapy ◽  
Lymphoblastic Leukemia ◽  
Adolescents And Young Adults ◽  
Increased Risk ◽  
Cerebral Sinus Venous Thrombosis ◽  
Cerebral Sinus ◽  
Sinus Venous Thrombosis

Pediatric acute lymphoblastic leukemia regimens include large L-asparaginase dosages and steroids, which are associated with an increased risk of venous thromboemboli in adolescents and young adults. Herein, we report the case of an 18-year-old male with acute lymphoblastic leukemia, who was treated with the pediatric regimen, in which edoxaban was employed as a prophylaxis against cerebral sinus venous thrombosis. The event happened on day 20 of induction therapy, when brain magnetic resonance imaging demonstrated a cerebral sinus venous thrombosis in the superior sagittal sinus. Anticoagulation therapy was initiated, and the patient’s symptoms disappeared 3 days later. The induction therapy was restarted after an interruption of 16 days, and the consolidation therapies, which included L-asparaginase and steroids, were completed. Edoxaban was administered as a prophylaxis during the consolidation therapy. There were no further adverse events. Edoxaban could be an effective prophylaxis for coagulation complications in adolescents and young adults with acute lymphoblastic leukemia.

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