Abstract

Venous thromboembolism (VTE) is a well-known complication of the treatment of pediatric acute lymphoblastic leukemia (ALL). We analyzed 1026 ALL patients 1–18-years-old, who were enrolled into the AIEOP-BFM ALL 2000 or 2009 studies in Austria, with regard to the incidence and risk factors of VTE. The 2.5-year cumulative incidence (CI) of VTE ≥ grade 2 was 4%±1% (n = 36/1026). Twenty VTE (56%) were found in the central nervous system (19 cerebral venous sinus and 1 cortical vein thrombosis), and 16 (44%) at other sites (7 deep vein thromboses (DVT) of the lower extremity, 4 DVT of the upper extremity, 4 central venous line-thromboses, 1 pulmonary embolism). Most VTE occurred during induction and early consolidation therapy (81%) and were associated with L-asparaginase within 4 and corticosteroids withing 1 week(s) preceding the event (89 and 86%, respectively). In multivariable analysis, two independent risk factors were found. Patients 10–18-years-old had an increased (hazard-ratio: 2.156, p = 0.0389), whereas treatments in trial AIEOP-BFM ALL 2009 had a lower risk for VTE (hazard-ratio: 0.349, p = 0.0270). In conclusion, the 2.5-year CI of VTE among our pediatric patient cohort was <5% and adolescent age was the main patient-related risk factor. This older age group might benefit from primary prophylactic measures.

摘要

静脉血栓栓塞症 (VTE) 是治疗小儿急性淋巴细胞白血病 (ALL) 的一种众所周知的并发症。我们分析了 1026 名 1-18 岁的 ALL 患者，他们被纳入奥地利的 AIEOP-BFM ALL 2000 年或 2009 年研究，了解 VTE 的发生率和危险因素。VTE ≥ 2 级的 2.5 年累积发生率 (CI) 为 4%±1% (n = 36/1026)。20 例 VTE (56%) 发生在中枢神经系统（19 例脑静脉窦和 1 例皮质静脉血栓形成），16 例 (44%) 发生在其他部位（7 例下肢深静脉血栓形成 (DVT)，4 例下肢 DVT上肢，4例中心静脉线-血栓形成，1例肺栓塞）。大多数 VTE 发生在诱导和早期巩固治疗期间 (81%)，并且与事件发生前 4 周内的左旋门冬酰胺酶和 1 周内的皮质类固醇有关（89 和 86%，分别）。在多变量分析中，发现了两个独立的危险因素。10-18 岁患者的 VTE 风险增加（风险比：2.156，p = 0.0389），而 AIEOP-BFM ALL 2009 试验中的治疗具有较低的 VTE 风险（风险比：0.349，p = 0.0270）。总之，我们的儿科患者队列中 VTE 的 2.5 年 CI <5%，青少年年龄是主要的患者相关风险因素。这个年龄较大的年龄组可能会受益于初级预防措施。5% 和青少年年龄是与患者相关的主要危险因素。这个年龄较大的年龄组可能会受益于初级预防措施。5% 和青少年年龄是与患者相关的主要危险因素。这个年龄较大的年龄组可能会受益于初级预防措施。