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

Autor: Rank CU; Pediatric Oncology Research Laboratory and.; Department of Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark., Toft N; Department of Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark., Tuckuviene R; Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark., Grell K; Pediatric Oncology Research Laboratory and.; Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences., Nielsen OJ; Department of Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark., Frandsen TL; Department of Pediatrics and Adolescent Medicine, Rigshospitalet, and., Marquart HVH; Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark., Albertsen BK; Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark., Tedgård U; Department of Pediatrics and Coagulation Disorders, Lund University Hospital, Malmö, Sweden., Hallböök H; Department of Medical Sciences (Hematology), Uppsala University Hospital, Uppsala, Sweden., Ruud E; Department of Paediatric Medicine, Rikshospitalet, Oslo University Hospital, Oslo, Norway., Jarvis KB; Department of Paediatric Medicine, Rikshospitalet, Oslo University Hospital, Oslo, Norway., Quist-Paulsen P; Department of Hematology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway., Huttunen P; Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Hospital, Helsinki, Finland., Wartiovaara-Kautto U; Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland., Jónsson ÓG; Children's Hospital, Landspitali, University Hospital, Reykjavík, Iceland., Trakymiene SS; Center for Pediatric Oncology and Hematology, Children's Hospital, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania., Griškevičius L; Department of Hematology, Oncology, and Transfusion Medicine Center, Vilnius University Hospital Santaros Klinikos and Vilnius University, Vilnius, Lithuania., Saks K; Department of Oncohematology, Tallinn Children's Hospital, Tallinn, Estonia., Punab M; Department of Hematology and Oncology, Tartu University Hospital, Tartu, Estonia; and., Schmiegelow K; Pediatric Oncology Research Laboratory and.; Department of Pediatrics and Adolescent Medicine, Rigshospitalet, and.; Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Denmark.
Jazyk: angličtina
Zdroj: Blood [Blood] 2018 May 31; Vol. 131 (22), pp. 2475-2484. Date of Electronic Publication: 2018 Apr 16.
DOI: 10.1182/blood-2018-01-827949
Abstrakt: 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 (RR age , 4.7 [95% CI, 3.1-7.1]; RR enlarged lymph nodes , 2.0 [95% CI, 1.2-3.1]; RR mediastinal 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.
(© 2018 by The American Society of Hematology.)
Databáze: MEDLINE
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