Thromboembolism in acute lymphoblastic leukemia: results of NOPHO ALL2008 protocol treatment in patients aged 1 to 45 years

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Thromboembolism in acute lymphoblastic leukemia : results of NOPHO ALL2008 protocol treatment in patients aged 1 to 45 years

Rank, Cecilie Utke (author): Univ Copenhagen, Rigshosp, Pediat Oncol Res Lab, Copenhagen, Denmark;Univ Copenhagen, Rigshosp, Dept Hematol, Copenhagen, Denmark

Toft, Nina (author): Univ Copenhagen, Rigshosp, Dept Hematol, Copenhagen, Denmark

Tuckuviene, Ruta (author): Aalborg Univ Hosp, Dept Pediat, Aalborg, Denmark

Grell, Kathrine (author): Univ Copenhagen, Fac Hlth & Med Sci, Dept Publ Hlth, Sect Biostat, Copenhagen, Denmark

Nielsen, Ove Juul (author): Univ Copenhagen, Rigshosp, Dept Hematol, Copenhagen, Denmark

Frandsen, Thomas Leth (author): Univ Copenhagen, Rigshosp, Dept Pediat & Adolescent Med, Blegdamsvej 9, DK-2100 Copenhagen, Denmark

Marquart, Hanne Vibeke Hansen (author): Univ Copenhagen, Rigshosp, Dept Clin Immunol, Copenhagen, Denmark

Albertsen, Birgitte Klug (author): Aarhus Univ Hosp, Dept Pediat, Aarhus, Denmark

Tedgard, Ulf (author): Lund Univ Hosp, Dept Pediat & Coagulat Disorders, Malmo, Sweden

Hallböök, Helene (author): Uppsala universitet,Hematologi

Ruud, Ellen (author): Oslo Univ Hosp, Rikshosp, Dept Paediat Med, Oslo, Norway

Jarvis, Kirsten Brunsvig (author): Oslo Univ Hosp, Rikshosp, Dept Paediat Med, Oslo, Norway

Quist-Paulsen, Petter (author): Trondheim Reg & Univ Hosp, St Olavs Hosp, Dept Hematol, Trondheim, Norway

Huttunen, Pasi (author): Helsinki Univ Hosp, Childrens Hosp, Dept Pediat Hematol Oncol & Stem Cell Transplanta, Helsinki, Finland

Wartiovaara-Kautto, Ulla (author): Helsinki Univ Hosp, Ctr Comprehens Canc, Dept Hematol, Helsinki, Finland;Univ Helsinki, Helsinki, Finland

Jonsson, Olafur Gisli (author): Univ Hosp, Landspitali, Childrens Hosp, Reykjavik, Iceland

Trakymiene, Sonata Saulyte (author): Vilnius Univ Hosp Santaros Klin, Childrens Hosp, Ctr Pediat Oncol & Hematol, Vilnius, Lithuania

Griskevicius, Laimonas (author): Vilnius Univ Hosp Santaros Klin, Dept Hematol Oncol & Transfus Med Ctr, Vilnius, Lithuania;Vilnius Univ, Vilnius, Lithuania

Saks, Kadri (author): Tallinn Childrens Hosp, Dept Oncohematol, Tallinn, Estonia

Punab, Mari (author): Tartu Univ Hosp, Dept Hematol & Oncol, Tartu, Estonia

Schmiegelow, Kjeld (author): Univ Copenhagen, Rigshosp, Pediat Oncol Res Lab, Copenhagen, Denmark;Univ Copenhagen, Rigshosp, Dept Pediat & Adolescent Med, Blegdamsvej 9, DK-2100 Copenhagen, Denmark;Univ Copenhagen, Fac Med, Inst Clin Med, Copenhagen, Denmark

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AMER SOC HEMATOLOGY, 2018
2018
English.
In: Blood. - : AMER SOC HEMATOLOGY. - 0006-4971 .- 1528-0020. ; 131:22, s. 2475-2484

Related links:: https://ashpublicati...; show more...; https://urn.kb.se/re...; https://doi.org/10.1...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

Thromboembolism frequently occurs during acute lymphoblastic leukemia (ALL) therapy. We prospectively registered thromboembolic events during the treatment of 1772 consecutive Nordic/Baltic patients with ALL aged 1 to 45 years who were treated according to the Nordic Society of Pediatric Hematology and Oncology ALL2008 protocol (July 2008-April 2017). The 2.5-year cumulative incidence of thromboembolism (N = 137) was 7.9% (95% confidence interval [CI], 6.6-9.1); it was higher in patients aged at least 10 years (P < .0001). Adjusted hazard ratios (HRas) were associated with greater age (range, 10.0-17.9 years: HRa, 4.9 [95% CI, 3.1-7.8; P < .0001]; 18.0-45.9 years: HRa, 6.06 [95% CI, 3.65-10.1; P < .0001]) and mediastinal mass at ALL diagnosis (HRa, 2.1; 95% CI, 1.0-4.3; P = .04). In a multiple absolute risk regression model addressing 3 thromboembolism risk factors, age at least 10 years had the largest absolute risk ratio (RRage, 4.7 [95% CI, 3.1-7.1]; RRenlarged (lymph nodes), 2.0 [95% CI, 1.2-3.1]; RRmediastinal mass, 1.6 [95% CI, 1.0-2.6]). Patients aged 18.0 to 45.9 years had an increased hazard of pulmonary embolism (HRa, 11.6; 95% CI, 4.02-33.7; P < .0001), and patients aged 10.0 to 17.9 years had an increased hazard of cerebral sinus venous thrombosis (HRa, 3.3; 95% CI, 1.5-7.3; P = .003) compared with children younger than 10.0 years. Asparaginase was truncated in 38/128 patients with thromboembolism, whereas thromboembolism diagnosis was unassociated with increased hazard of relapse (P = .6). Five deaths were attributable to thromboembolism, and patients younger than 18.0 years with thromboembolism had increased hazard of dying compared with same-aged patients without thromboembolism (both P <= .01). In conclusion, patients aged at least 10 years could be candidates for preemptive antithrombotic prophylaxis. However, the predictive value of age 10 years or older, enlarged lymph nodes, and mediastinal mass remain to be validated in another cohort.

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Hematology

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Thromboembolism in acute lymphoblastic leukemia : results of NOPHO ALL2008 protocol treatment in patients aged 1 to 45 years

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