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Thrombotic complications in childhood acute lymphoblastic leukemia: a meta-analysis of 17 prospective studies
Vanesa Caruso1, Licia Iacoviello, Augusto Di Castelnuovo
1Laboratory of Genetic and Environmental Epidemiology, Research Laboratories, Centre for High Technology Research and Education in Biomedical Sciences, Catholic University, 86100 Campobasso, Italy.
Insights
The risk of thrombosis in children with acute lymphoblastic leukemia (ALL) is significant, affecting 5.2% of patients. Certain treatments and genetic factors increase this risk, requiring careful monitoring.
Area of Science:
- Pediatric Oncology
- Hematology
- Thrombosis Research
Background:
- Thrombosis risk in pediatric acute lymphoblastic leukemia (ALL) varies widely (1-37%) due to limited study data.
- Accurate estimation of thrombosis incidence in children with ALL is challenging.
Purpose of the Study:
- To precisely estimate the frequency of thrombosis in pediatric ALL.
- To identify disease, treatment, and host factors contributing to thrombosis in ALL.
Main Methods:
- Meta-analysis of 17 prospective studies.
- Inclusion of data from 1752 children with ALL.
Main Results:
- Overall thrombosis rate in pediatric ALL was 5.2% (95% CI: 4.2-6.4).
- Highest risk observed during induction therapy, with prolonged low-dose asparaginase, anthracyclines, and prednisone.
- Central lines and thrombophilic genetic abnormalities were associated with increased thrombosis risk.
Conclusions:
- The thrombotic risk in children with ALL is substantial.
- Subgroup analysis identifies high-risk patients, informing future risk-reduction strategies.
Abstract:
The risk of thrombosis in children with acute lymphoblastic leukemia (ALL) reportedly ranges between 1% and 37%. Epidemiologic studies have usually been hampered by small numbers, making accurate estimates of thrombosis risk in ALL patients very difficult. The aim of this study was to better estimate the frequency of this complication and to define how the disease, its treatment, and the host contribute to its occurrence. We made an attempt to combine and analyze all published data on the association between pediatric ALL and thrombosis, by using a meta-analytic method. The rate of thrombosis in 1752 children from 17 prospective studies was 5.2% (95% CI: 4.2-6.4). The risk varies depending on several factors. Most of the events occurred during the induction phase of therapy. Lower doses of asparaginase (ASP) for long periods were associated with the highest incidence of thrombosis, as were anthracyclines and prednisone (instead of dexamethasone). The presence of central lines and of thrombophilic genetic abnormalities also appeared to be frequently associated with thrombosis. In conclusion, the overall thrombotic risk in ALL children was significant, and the subgroup analysis was able to identify high-risk individuals, a finding that will hopefully guide future prospective studies aimed at decreasing this risk.
