Cerebral sinus venous thrombosis in indian pediatric patients with acute lymphoblastic leukemia: Incidence, risk factors, and outcome

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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Treatment Induced Cerebral Sinus Venous Thrombosis in Childhood Acute Lymphoblastic Leukemia: New Risk Factors to Consider

10.22541/au.161228345.59275964/v1 ◽

2021 ◽

Author(s):

Habib El-Khoury ◽

Omran Saifi ◽

Mohamad Chahrour ◽

Salame Haddad ◽

Khaled Ghanem ◽

...

Keyword(s):

Risk Factors ◽

Acute Lymphoblastic Leukemia ◽

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Mediastinal Mass ◽

Lymphoblastic Leukemia ◽

Cerebral Sinus Venous Thrombosis ◽

Cerebral Sinus ◽

Sinus Venous Thrombosis

Background: Cerebral Sinus Venous Thrombosis (CSVT) is one of many side effects encountered during acute lymphoblastic leukemia (ALL) therapy. Due to the rarity of cases, lack of data, consensus management, no recommendations exist to target the population at risk. Methods: This is a retrospective chart review of 229 consecutive patients diagnosed with ALL and aged 1–21 years, treated at the Children’s Cancer Institute (CCI) between October 2007 and February 2017. Results: The incidence of CSVT was 10.5%. Using univariate analysis, increased risk of CSVT was observed with male gender, age >10 years, T-cell immunophenotype, intermediate/high risk disease, maximum Triglyceride (TG) level of > 615 mg/dL, presence of mediastinal mass, and larger body surface area. With multivariate analysis, the only statistically significant risk factors were maximum TG level, body surface area (BSA), presence of mediastinal mass, and risk stratification (intermediate/high risk). Conclusion: Our study was able to unveil TG level of > 615 mg/dL, mediastinal mass, and a larger body surface area as novel risk factors that have not been previously discussed in the literature.

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CLINICAL PROFILE AND RISK FACTORS FOR CEREBRAL SINUS VENOUS THROMBOSIS IN A PAEDIATRIC COHORT FROM A TERTIARY CARE CENTRE

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2016/453 ◽

2016 ◽

Vol 3 (41) ◽

pp. 2031-2034

Author(s):

Justin C ◽

Manivannan M.R ◽

Ramu S

Keyword(s):

Risk Factors ◽

Venous Thrombosis ◽

Tertiary Care ◽

Clinical Profile ◽

Care Centre ◽

Tertiary Care Centre ◽

Paediatric Cohort ◽

Cerebral Sinus Venous Thrombosis ◽

Cerebral Sinus ◽

Sinus Venous Thrombosis

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Cerebral Sinus Venous Thrombosis and Prothrombotic Risk Factors in Children

Journal of Pediatric Hematology/Oncology ◽

10.1097/mph.0000000000001149 ◽

2018 ◽

Vol 40 (6) ◽

pp. e369-e372 ◽

Cited By ~ 2

Author(s):

Alper Ozcan ◽

Mehmet Canpolat ◽

Selim Doganay ◽

Ekrem Unal ◽

Musa Karakukcu ◽

...

Keyword(s):

Risk Factors ◽

Venous Thrombosis ◽

Cerebral Sinus Venous Thrombosis ◽

Prothrombotic Risk Factors ◽

Cerebral Sinus ◽

Sinus Venous Thrombosis

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Prospective Study on Incidence, Risk Factors, and Long-Term Outcome of Osteonecrosis in Pediatric Acute Lymphoblastic Leukemia

Journal of Clinical Oncology ◽

10.1200/jco.2011.37.3217 ◽

2011 ◽

Vol 29 (31) ◽

pp. 4143-4150 ◽

Cited By ~ 81

Author(s):

Mariël L. te Winkel ◽

Rob Pieters ◽

Wim C.J. Hop ◽

Hester A. de Groot-Kruseman ◽

Maarten H. Lequin ◽

...

Keyword(s):

Risk Factors ◽

Acute Lymphoblastic Leukemia ◽

Cumulative Incidence ◽

Multivariate Regression ◽

Pediatric Patients ◽

Lymphoblastic Leukemia ◽

Long Term Outcome ◽

Female Sex ◽

Incidence Risk

Purpose We studied cumulative incidence, risk factors, therapeutic strategies, and outcome of symptomatic osteonecrosis in pediatric patients with acute lymphoblastic leukemia (ALL). Patients and Methods Cumulative incidence of osteonecrosis was assessed prospectively in 694 patients treated with the dexamethasone-based Dutch Child Oncology Group–ALL9 protocol. Osteonecrosis was defined by development of symptoms (National Cancer Institute grade 2 to 4) during treatment or within 1 year after treatment discontinuation, confirmed by magnetic resonance imaging. We evaluated risk factors for osteonecrosis using logistic multivariate regression. To describe outcome, we reviewed clinical and radiologic information after antileukemic treatment 1 year or more after osteonecrosis diagnosis. Results Cumulative incidence of osteonecrosis at 3 years was 6.1%. After adjustment for treatment center, logistic multivariate regression identified age (odds ratio [OR], 1.47; P < .01) and female sex (OR, 2.23; P = .04) as independent risk factors. Median age at diagnosis of ALL in patients with osteonecrosis was 13.5 years, compared with 4.7 years in those without. In 21 (55%) of 38 patients with osteonecrosis, chemotherapy was adjusted. Seven patients (18%) underwent surgery: five joint-preserving procedures and two total-hip arthroplasties. Clinical follow-up of 35 patients was evaluated; median follow-up was 4.9 years. In 14 patients (40%), symptoms completely resolved; 14 (40%) had symptoms interfering with function but not with activities of daily living (ADLs; grade 2); seven (20%) had symptoms interfering with ADLs (grade 3). In 24 patients, radiologic follow-up was available; in six (25%), lesions improved/disappeared; in 13 (54%), lesions remained stable; five (21%) had progressive lesions. Conclusion Six percent of pediatric patients with ALL developed symptomatic osteonecrosis during or shortly after treatment. Older age and female sex were risk factors. After a median follow-up of 5 years, 60% of patients had persistent symptoms.

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