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Bleeding and thrombosis in children with acute lymphoblastic leukaemia, treated according to the ALL-BFM-90 protocol
A H Sutor1, V Mall, K B Thomas
1Universitäts-Kinderklinik, Freiburg, Germany.
Insights
Children undergoing acute lymphoblastic leukemia (ALL) treatment faced hemostatic complications like thrombosis and bleeding. These events, particularly during induction therapy with E. coli L-asparaginase and glucocorticoids, highlight a significant risk factor.
Area of Science:
- Pediatric Hematology
- Oncology
- Hemostasis and Thrombosis
Background:
- Acute lymphoblastic leukemia (ALL) treatment protocols, such as ALL-BFM-90, are critical for pediatric cancer care.
- Hemostatic complications, including thrombosis and bleeding, can significantly impact patient outcomes during ALL therapy.
Purpose of the Study:
- To evaluate the incidence and types of hemostatic complications in children treated for ALL using the ALL-BFM-90 protocol.
- To identify potential risk factors associated with these complications.
Main Methods:
- A multi-center retrospective survey was conducted across 77 BFM-treatment centers.
- Data from 1100 pediatric patients undergoing ALL treatment were analyzed.
- Incidence, type, and timing of thrombotic and bleeding events were recorded.
Main Results:
- Hemostatic complications occurred in 2.8% of patients (31/1100), with 19 thrombotic and 12 bleeding events.
- Central nervous system involvement was the most frequent complication (42%).
- Most complications (90%) occurred during induction therapy, particularly with concurrent E. coli L-asparaginase and glucocorticoid administration.
Conclusions:
- The combination of E. coli L-asparaginase and glucocorticoids during induction therapy may represent an increased risk factor for thromboembolic events in ALL treatment.
- Understanding these risks is crucial for optimizing pediatric ALL treatment protocols and patient safety.
Abstract:
A multi-center retrospective survey was conducted to evaluate the incidence and types of hemostatic complications occurring in children with acute lymphoblastic leukemia (ALL) during treatment according to the ALL-BFM-90 treatment protocol. All of the BFM-treatment centers (n = 77) were approached and a 95% response rate with information on 1100 patients was obtained. Thrombotic or bleeding episodes occurred in 31 patients (2.8%), 19 of whom had thrombosis and 12 bleeding complications, involving the central nervous system (42%), the subclavian vein (29%), the gastro-intestinal tract, skin, lower extremities or pelvis (29%). Recovery was noted in 28 of 31 patients, while 3 died as a result of hemostatic complications. Bleeding or thrombosis occurred in patients receiving prophylactic substitution with plasma or plasma-derived concentrates (n = 16) as well as in those without substitution (n = 13). The majority of hemostatic complications (90%) occurred during the induction therapy of the treatment protocol, in particular during the period which included simultaneous administration of glucocorticoids and E. coli L-asparaginase. The concurrent administration of E. coli L-asparaginase and glucocorticoids may be an additional risk factor for thromboembolic events during therapy according to the ALL-BFM-90 protocol.