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Management of thrombotic complications in acute lymphoblastic leukemia
1Carman and Ann Adams Department of Pediatrics, Division of Hematology/Oncology, Wayne State University School of Medicine, Detroit, MI, USA, ayeshazia77@gmail.com.
Insights
Pediatric acute lymphoblastic leukemia (ALL) patients face a high risk of thromboembolism, influenced by treatments like asparaginase and steroids. Early intervention is crucial to prevent severe outcomes and reduce mortality from these blood clots.
Area of Science:
- Pediatric Hematology Oncology
- Thrombosis and Hemostasis
- Cancer Treatment Complications
Background:
- Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer.
- Thromboembolism is a frequent complication in children with ALL.
- Risk factors include specific chemotherapy agents, central venous lines, and inherited clotting disorders.
Purpose of the Study:
- To review current knowledge on the treatment of thrombosis in pediatric ALL.
- To discuss strategies for the prevention of thromboembolism in this patient group.
- To address the lack of randomized trials and practice variations in VTE management for pediatric ALL.
Main Methods:
- Literature review of existing studies on pediatric ALL and thromboembolism.
- Analysis of established risk factors and incidence rates.
- Synthesis of current treatment and prevention guidelines.
Main Results:
- Thromboembolism incidence in pediatric ALL varies but is highest during induction and intensification chemotherapy phases.
- Mortality from thromboembolic events ranges from 2-4%, with a 7-10% recurrence risk.
- Established risk factors include asparaginase, steroids, central venous lines, and thrombophilia.
Conclusions:
- Thrombosis is a significant concern in pediatric ALL, necessitating proactive management.
- Standardized treatment protocols are needed due to practice variations and limited trial data.
- Prevention and timely treatment are essential to mitigate morbidity and mortality.
Abstract:
Acute lymphoblastic leukemia (ALL) is the most common type of cancer diagnosed in children, and has been reported as the most common malignancy associated with thromboembolism in the pediatric age group. Treatment with Escherichia coli asparaginase, concomitant steroids, presence of central venous lines, and thrombophilic abnormalities are established risk factors for thromboembolism. The incidence varies with age, co-morbidities and chemotherapy regimens but the risk is highest during the induction and intensification phases. Treatment is necessary in majority of children to prevent serious sequelae. Mortality from thromboembolic events in any location is 2 to 4 % and the risk of recurrence is 7 to 10 %, further enhanced in the setting of malignancy. Randomized trials of venous thromboembolism (VTE) management in pediatric patients with ALL are lacking due to the low overall incidence, resulting in considerable variation in practice. The objective of this article is to review current knowledge on the treatment and prevention of thrombosis associated with pediatric ALL.
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