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CC BY 4.0 · TH Open 2019; 03(02): e109-e116
DOI: 10.1055/s-0039-1688412
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Venous Thrombosis in Children with Acute Lymphoblastic Leukemia Treated on DCOG ALL-9 and ALL-10 Protocols: The Effect of Fresh Frozen Plasma

Irene L. M. Klaassen
1   Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
2   Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
,
Charlotte C. M. Zuurbier
1   Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
,
Barbara A. Hutten
3   Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, Amsterdam, The Netherlands
,
Cor van den Bos
4   Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
5   Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
,
A. Y. Netteke Schouten
4   Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
5   Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
,
Eva Stokhuijzen
1   Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
,
C. Heleen van Ommen
6   Department of Pediatric Hematology, Erasmus Medical Center/Sophia Children's Hospital, Rotterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

10 October 2018

08 March 2019

Publication Date:
24 April 2019 (online)

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Abstract

Background Venous thromboembolism (VTE) is an important complication for treatment of acute lymphoblastic leukemia (ALL) in children. Especially, ALL treatment, with therapeutics such as asparaginase and steroids, increases the thrombotic risk by reduction in procoagulant and anticoagulant proteins. Replacement of deficient natural anticoagulants by administration of fresh frozen plasma (FFP) may have a preventive effect on the occurrence of VTE.

Methods We retrospectively analyzed all consecutive children (≤18 years) with ALL, treated on the Dutch Childhood Oncology Group (DCOG) ALL-9 and ALL-10 protocols at the Emma Children's Hospital Academic Medical Center between February 1997 and January 2012, to study the effect of FFP on VTE incidence, antithrombin and fibrinogen plasma levels, and VTE risk factors.

Results In total, 18/205 patients developed VTE (8.8%; 95% confidence interval [CI]: 4.9–12.7%). In all patients, VTE occurred after asparaginase administration. In total, 82/205 patients (40%) received FFP. FFP supplementation did not prevent VTE or alter plasma levels of antithrombin or fibrinogen. In the multivariate analysis, VTE occurred significantly more frequently in children ≥12 years (odds ratio [OR]: 3.89; 95% CI: 1.29–11.73) and treated according to the ALL-10 protocol (OR: 3.71; 95% CI: 1.13–12.17).

Conclusion FFP supplementation does not seem to be beneficial in the prevention of VTE in pediatric ALL patients. In addition, age ≥12 years and treatment according to the DCOG ALL-10 protocol with intensive and prolonged administration of asparaginase in combination with prednisone are risk factors. There is a need for effective preventive strategies in ALL patients at high risk for VTE.

Keywords

Acute lymphoblastic leukemia - fresh frozen plasma - pediatric - risk factors - venous thromboembolism
 

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