A minor role of asparaginase in predisposing to cerebral venous thromboses in adult acute lymphoblastic leukemia patients.

Saara Roininen,Outi Laine,Riikka Räty,Marjaana Säily,Maria Rämet,Marjatta Sinisalo,Ulla Wartiovaara‐Kautto,Marko Vesanen,Marjut Kauppila,Esa Jantunen,Erkki Elonen

doi:10.1002/cam4.1094

Abstract

Cerebral venous thrombosis (CVT) covers up to a third of all venous thromboses (VTs) detected in patients with acute lymphoblastic leukemia (ALL). It usually hampers patients' lives and may also endanger efficient leukemia treatment. Although many factors have been suggested to account for an elevated risk of VTs in patients with ALL, there still is a lack of studies focusing on CVTs and especially in the setting of adult ALL patients. We studied in our retrospective population‐based cohort the occurrence, characteristics, as well as risk factors for VTs in 186 consecutively diagnosed Finnish adult ALL patients treated with a national pediatric‐inspired treatment protocol ALL2000. In the risk factor analyses for VTs we found a distinction of the characteristics of the patients acquiring CVT from those with other kinds of VTs or without thrombosis. In contrast to previous studies we were also able to compare the effects of asparaginase in relation to CVT occurrence. Notably, more than half of the CVTs were diagnosed prior the administration of asparaginase which accentuates the role of other risk factors on the pathophysiology of CVT compared to truncal or central venous line (CVL) VTs in adult ALL patients.

Highlights

Venous thromboses cause high mortality in cancer patients [1, 2]
We performed a detailed analysis of the occurrence and risk factors for venous thromboses (VTs) in a consecutive series of adult patients diagnosed in Finland in 2000–2012 and treated according to a national study protocol ALL2000
Risk factors for truncal or central venous line (CVL) VTs were as hypothesized and reflected many of the traditional hazards for thrombosis detected in the general population

Summary

Introduction

Venous thromboses cause high mortality in cancer patients [1, 2]. Most VTs including cerebral venous thromboses (CVTs) in ALL patients occur during the first 2 or 3 months of leukemia treatment [3,4,5]. CVTs cover up to over 30% of all cases of VTs in ALL patients. It leads to dramatic consequences such as. Etiological factors identified in nonleukemia patient cohorts include female sex, hormonal manipulation (e.g., oral contraceptives), certain malignancies, and head trauma, but they explain less than half of the CVT cases [11, 12]. CVT is a relatively common complication in ALL patients, we still do not know the specific biological basis of this event [3, 10]

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