Cerebral venous thrombosis in adult patients with acute lymphoblastic leukemia or lymphoblastic lymphoma during induction chemotherapy with l-asparaginase: The GRAALL experienceReport as inadecuate




Cerebral venous thrombosis in adult patients with acute lymphoblastic leukemia or lymphoblastic lymphoma during induction chemotherapy with l-asparaginase: The GRAALL experience - Download this document for free, or read online. Document in PDF available to download.

* Corresponding author 1 Hôpital Morvan Brest 2 Laboratoire d-Hématologie Purpan 3 CHU Nantes 4 IHU - Imagine - Institut des maladies génétiques 5 CRCL - Centre de Recherche en Cancérologie de Lyon 6 Hôpital Edouard Herriot 7 Service d-hématologie clinique 8 CHU Clermont-Ferrand 9 Centre Hospitalier Dunkerque 10 CHU Nancy - Centre hospitalier de Nancy 11 Hôpital de Perpignan 12 Service Hématologie 13 Service d-hématologie 14 CHR Metz 15 CHU Henri Mondor 16 Centre Hospitalier de Meaux 17 CHU Angers - Centre Hospitalier Universitaire d-Angers 18 Lymphocyte et cancer 19 Hôpital Saint-Louis 20 Service des maladies du sang

Abstract : Central nervous system CNS thrombotic events are a well-known complication of acute lymphoblastic leukemia ALL induction therapy, especially with treatments including l-asparaginase l-ASP. Data on risk factors and clinical evolution is still lacking in adult patients. We report on the clinical evolution of 22 CNS venous thrombosis cases occurring in 708 adults treated for ALL or lymphoblastic lymphoma LL with the Group for Research on Adult Acute Lymphoblastic Leukemia GRAALL-induction protocol, which included eight L-ASP 6,000 IU-m2 infusions. The prevalence of CNS thrombosis was 3.1%. CNS thrombosis occurred after a median of 18 days range: 11–31 when patients had received a median of three l-ASP injections range: 2–7. Patients with CNS thrombosis exhibited a median antithrombin AT nadir of 47.5% range: 36–67% at Day 17 range: D3–D28, and 95% of them exhibited AT levels lower than 60%. There were no evident increase in hereditary thrombotic risk factors prevalence, and thrombosis occurred despite heparin prophylaxis which was performed in 90% of patients. Acquired AT deficiency was frequently detected in patients with l-ASP-based therapy, and patients with CNS thrombosis received AT prophylaxis 45% less frequently than patients without CNS thrombosis 83%, P = 0.0002. CNS thrombosis was lethal in 5% of patients, while 20% had persistent sequelae. One patient received all planned l-ASP infusions without recurrence of CNS thrombotic whereas l-ASP injections were discontinued in 20 patients during the management of thrombosis without a significant impact on overall survival P = 0.4. Am. J. Hematol. 90:986–991, 2015. © 2015 Wiley Periodicals, Inc





Author: Marie-Anne Couturier - Françoise Huguet - Patrice Chevallier - Felipe Suarez - Xavier Thomas - Martine Escoffre-Barbe - Victoria

Source: https://hal.archives-ouvertes.fr/



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