Thrombosis and acute lymphoblastic leukaemia

Area of Science:

• Oncology
• Hematology
• Vascular Medicine

Background:

• Venous thrombosis is more common in acute lymphoblastic leukemia (ALL) patients than in other cancers.
• Incidence rates vary widely (1-36%) based on chemotherapy and detection methods.
• Risk factors include increased thrombin generation and reduced anti-thrombin (AT) levels due to asparaginase therapy.

Purpose of the Study:

• To review the causes, clinical features, and treatment of venous thrombosis in ALL patients.
• To explore the role of asparaginase and other factors in thrombosis development.
• To assess current evidence for preventative and therapeutic strategies.

Main Methods:

• Literature review of studies on venous thrombosis in ALL.
• Analysis of factors influencing thrombosis risk, including chemotherapy agents and patient characteristics.
• Evaluation of existing data on anticoagulant and AT concentrate use.

Main Results:

• Asparaginase therapy, particularly with Escherichia coli strains, increases thrombosis risk.
• Central venous catheters are frequently associated with upper extremity venous thrombosis.
• Cerebral venous sinus thrombosis occurs in 1-3% of patients, a unique complication of asparaginase treatment.
• Conflicting data exists regarding preventative measures and treatment efficacy for thrombosis in ALL.

Conclusions:

• Venous thrombosis is a significant complication in ALL treatment, influenced by specific therapies like asparaginase.
• Current evidence is insufficient to recommend routine anticoagulation or AT concentrate for prevention or treatment.
• Further research is needed to identify high-risk patients and establish effective management strategies.