Department of Haematology, F4-224, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
Thromb Haemost. 2013 Apr;109(4):633-42. doi: 10.1160/TH12-11-0845. Epub 2013 Jan 31.
Treatment of acute lymphoblastic leukaemia (ALL) is frequently complicated by venous thromboembolism (VTE). The efficacy and optimal approach of VTE prevention are unclear, particularly in adult patients. We assessed the effect of thromboprophylaxis on symptomatic VTE incidence in cycle 1 of ALL treatment in adult patients. Secondly, we explored potential etiologic factors for VTE and the clinical impact of VTE on ALL outcome. We retrospectively assessed symptomatic VTE incidence and use of thromboprophylaxis in 240 adults treated for newly diagnosed ALL in the Dutch-Belgian HOVON-37 multicentre study (1999-2005). Potential etiologic factors were explored by analysis of patient and disease characteristics, impact of VTE on ALL outcome by analysis of complete remission and overall survival rates. Symptomatic VTE was observed in 24 of 240 patients (10%). Thromboprophylaxis differed by centre (prophylactic fresh frozen plasma (FFP) supplementation or no thromboprophylaxis) and was applied only during L-asparaginase in cycle 1. VTE incidence was significantly lower with FFP supplementation than without FFP (6% vs. 19%; adjusted odds ratio [OR] 0.28; 95% confidence interval [CI] 0.10-0.73). FFP did not influence antithrombin or fibrinogen plasma levels. Patients with VTE in cycle 1 had a significantly poorer complete remission rate (adjusted OR 0.18; 95% CI 0.07-0.50), particularly patients with cerebral venous thrombosis (adjusted OR 0.17; 95% CI 0.04-0.65). Our study suggests that prophylactic FFP supplementation effectively reduces symptomatic VTE incidence during ALL treatment in adults. This should be confirmed in a randomised controlled trial.
急性淋巴细胞白血病（ALL）的治疗常伴有静脉血栓栓塞症（VTE）。VTE 的预防效果和最佳方法尚不清楚，尤其是在成人患者中。我们评估了在 ALL 成人患者治疗的第 1 周期中，血栓预防对症状性 VTE 发生率的影响。其次，我们探讨了 VTE 的潜在病因因素以及 VTE 对 ALL 结局的临床影响。我们回顾性评估了在荷兰-比利时 HOVON-37 多中心研究（1999-2005 年）中，240 例新诊断 ALL 成人患者的症状性 VTE 发生率和血栓预防的使用情况。通过分析患者和疾病特征，以及通过分析完全缓解率和总生存率，探讨了 VTE 的潜在病因因素。在 240 例患者中，有 24 例（10%）观察到症状性 VTE。血栓预防因中心而异（预防性新鲜冷冻血浆（FFP）补充或无血栓预防），仅在第 1 周期的 L-门冬酰胺酶期间使用。FFP 补充组的 VTE 发生率明显低于无 FFP 补充组（6%比 19%；调整后的优势比[OR]0.28；95%置信区间[CI]0.10-0.73）。FFP 不影响抗凝血酶或纤维蛋白原的血浆水平。在第 1 周期中发生 VTE 的患者完全缓解率显著较低（调整后的 OR 0.18；95%CI 0.07-0.50），尤其是有脑静脉血栓形成的患者（调整后的 OR 0.17；95%CI 0.04-0.65）。我们的研究表明，在 ALL 成人患者的治疗中，预防性 FFP 补充可有效降低症状性 VTE 的发生率。这需要在随机对照试验中得到证实。
