Carman and Ann Adams Department of Pediatrics, Division of Hematology/Oncology, Wayne State University School of Medicine, Detroit, MI, USA,
Indian J Pediatr. 2013 Oct;80(10):853-62. doi: 10.1007/s12098-013-1158-9. Epub 2013 Aug 4.
Acute lymphoblastic leukemia (ALL) is the most common type of cancer diagnosed in children, and has been reported as the most common malignancy associated with thromboembolism in the pediatric age group. Treatment with Escherichia coli asparaginase, concomitant steroids, presence of central venous lines, and thrombophilic abnormalities are established risk factors for thromboembolism. The incidence varies with age, co-morbidities and chemotherapy regimens but the risk is highest during the induction and intensification phases. Treatment is necessary in majority of children to prevent serious sequelae. Mortality from thromboembolic events in any location is 2 to 4 % and the risk of recurrence is 7 to 10 %, further enhanced in the setting of malignancy. Randomized trials of venous thromboembolism (VTE) management in pediatric patients with ALL are lacking due to the low overall incidence, resulting in considerable variation in practice. The objective of this article is to review current knowledge on the treatment and prevention of thrombosis associated with pediatric ALL.
急性淋巴细胞白血病 (ALL) 是儿童中最常见的癌症类型，据报道也是儿科人群中与血栓栓塞最常见相关的恶性肿瘤。使用大肠杆菌天冬酰胺酶、同时使用类固醇、存在中心静脉导管和血栓形成异常是血栓栓塞的既定危险因素。发病率随年龄、合并症和化疗方案而变化，但在诱导和强化阶段风险最高。为了预防严重的后遗症，大多数儿童都需要进行治疗。任何部位的血栓栓塞事件的死亡率为 2%至 4%，复发风险为 7%至 10%，在恶性肿瘤的情况下进一步增加。由于总体发生率较低，导致儿科 ALL 患者静脉血栓栓塞 (VTE) 管理的随机试验缺乏，因此实践中存在很大差异。本文的目的是综述与儿科 ALL 相关的血栓形成的治疗和预防的现有知识。
