Venous thromboembolism in adolescents and young adults with acute lymphoblastic leukemia treated on a pediatric-inspired regimen Journal Article
| Authors: | Shimony, S.; Raman, H. S.; Flamand, Y.; Keating, J.; Paolino, J. D.; Valtis, Y. K.; Place, A. E.; Silverman, L. B.; Sallan, S. E.; Vrooman, L. M.; Brunner, A. M.; Neuberg, D. S.; Galinsky, I.; Garcia, J. S.; Winer, E. S.; Wadleigh, M.; Stone, R. M.; Connors, J. M.; DeAngelo, D. J.; Luskin, M. R. |
| Article Title: | Venous thromboembolism in adolescents and young adults with acute lymphoblastic leukemia treated on a pediatric-inspired regimen |
| Abstract: | Asparaginase (ASP)-containing regimens for acute lymphoblastic leukemia (ALL) are associated with venous thromboembolism (VTE). We evaluated the prevalence, risk factors, role of prophylaxis and clinical impact of VTE among adolescents and young adult (AYA) patients (15–50 years) treated on Dana-Farber Cancer Institute (DFCI) ALL protocols. The 1- and 2-year cumulative incidence of VTE were 31.9% (95% CI: 27.0%, 36.9%) and 33.5% (95% CI: 28.5%, 38.5%) respectively, with most events occurring during ASP-based consolidation phase (68.6%). VTE was more frequent in patients with overweight/obese vs. normal BMI (39.2% vs. 29.0%, p = 0.048). In a 1-year landmark analysis, the 4-year overall survival was 91.5%, without difference between patients with vs. without VTE (93.8% vs. 90.0%, p = 0.93). Relapse and non-relapse mortality rates were also similar. Among patients treated at Dana-Farber/Harvard Cancer Center, cerebral sinus vein thrombosis occurred in 3.6% of patients (8.5% of VTE events) in comparison to pulmonary embolism (32.9%) and deep vein thromboses (58.6%, 24.4% line-associated). In a Cox regression model for VTE free-time, elevated BMI was associated with shorter VTE free-time (HR 1.94 [95% CI 1.13-3.35], p = 0.018), while low molecular weight heparin (LMWH) prophylaxis as time-varying covariate was not. In conclusion, we found that VTE was frequent in AYAs treated on DFCI ALL protocols but did not impact survival outcomes. Overweight/obese BMI increased risk for VTE. © The Author(s) 2024. |
| Keywords: | adolescent; adult; controlled study; middle aged; young adult; major clinical study; overall survival; mortality; follow up; antineoplastic agent; antineoplastic combined chemotherapy protocols; incidence; prevalence; risk factors; obesity; deep vein thrombosis; retrospective study; risk factor; acute lymphoblastic leukemia; lung embolism; cancer center; proportional hazards model; prophylaxis; asparaginase; precursor cell lymphoblastic leukemia-lymphoma; immunophenotyping; epidemiology; drug therapy; karyotype; fondaparinux; venous thromboembolism; apixaban; cumulative incidence; etiology; protocol; complication; philadelphia chromosome negative cell; thrombosis prevention; cerebral sinus thrombosis; humans; human; male; female; article; b cell acute lymphoblastic leukemia; regression model |
| Journal Title: | Blood Cancer Journal |
| Volume: | 14 |
| ISSN: | 2044-5385 |
| Publisher: | Nature Publishing Group |
| Date Published: | 2024-10-31 |
| Start Page: | 191 |
| Language: | English |
| DOI: | 10.1038/s41408-024-01178-5 |
| PUBMED: | 39482298 |
| PROVIDER: | scopus |
| PMCID: | PMC11527869 |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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