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[Thrombosis in children with acute lymphoblastic leukemia treated with the COALL protocol]
S Eckhof-Donovan1, D Schwamborn, D Körholz
1Klinik für pädiatrische Hämatologie und Onkologie, Heinrich Heine-Universität, Düsseldorf.
Insights
Thrombotic events are a concern in childhood acute lymphoblastic leukemia (ALL) treatment. The COALL protocol showed a 2.1% thrombosis rate, with most linked to venous catheters.
Area of Science:
- Pediatric Oncology
- Hematology
Background:
- The COALL therapy protocol is used for childhood acute lymphoblastic leukemia (ALL).
- Thrombotic and hemorrhagic events are potential complications in cancer treatment.
Purpose of the Study:
- To investigate the incidence and characteristics of thrombotic events and hemorrhagic infarctions in children with ALL treated under the COALL protocol.
- To identify risk factors associated with these events.
Main Methods:
- A retrospective inquiry was conducted across participating hospitals.
- Data were collected on patients treated between January 1989 and December 1992.
- Clinical manifestations of thrombotic events and hemorrhagic infarctions were analyzed.
Main Results:
- A total of 2.1% of 286 treated patients experienced thrombotic events; no hemorrhagic infarctions were observed.
- Symptomatic thrombosis, often associated with continuous venous catheters, occurred in 1.4% of patients.
- Idiopathic thrombosis occurred in 0.6% of patients, with one case being life-threatening.
Conclusions:
- Thrombotic events are a relevant clinical issue in childhood ALL treated with the COALL protocol.
- Continuous venous catheters and specific therapy phases (e.g., induction therapy, asparaginase) are identified risk factors.
- Distinguishing between symptomatic and idiopathic thromboses is important for risk assessment.
Abstract:
To see whether the clinical manifestation of thrombotic events or hemorrhagic infarctions appears as a relevant problem when treating children with acute lymphoblastic leukemia (ALL) concerning the COALL therapy-protocol, we started an inquiry of the participating hospitals. The mentioned protocol was designed by the German Society for Pediatric Oncology and Hematology to treat ALL in childhood. All participants gave us information about the treatment period from January 1989 to December 1992. In 6 from 286 treated patients a thromboses appeared in clinical terms. None of them was connected with a lethal outcome. There was no observation of a hemorrhagic infarction. The overall thromboses frequency was 2.1%. In 1.4% patients "symptomatic" thrombosis developed close to a continuous venous catheter, which can be considered as a thrombogene risk factor. About 0.6% (2/286) of the patients developed the thrombotic events without another risk factor. They can be regarded as "idiopathic". 1/2 idiopathic thromboses led to a life threatening situation. There are two important factors that can enhance thromboses: 1) the therapy period, especially induction therapy and application of asparaginase and 2) a continuous venous catheter. The fact that asparaginase is not used during the induction therapy is a characteristic of the COALL protocol. It seems to be useful to differentiate between "idiopathic" and "symptomatic" thrombotic events, because "symptomatic" thromboses appear also in non-leukemic diseases quite frequently.