van Ommen C Heleen, Chan Anthony K C
Department of Pediatric Hematology, Emma Children's Hospital AMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Pediatrics, Division of Hematology/Oncology, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada.
Semin Thromb Hemost. 2014 Apr;40(3):371-81. doi: 10.1055/s-0034-1370795. Epub 2014 Mar 5.
The survival rate of children with cancer has increased impressively to almost 80% over the last decades as a result of improved diagnostic procedures and multimodal treatment strategies. Therefore, it becomes more and more important to prevent mortality and morbidity of treatment-associated complications, including venous thromboembolism (VTE). VTE occurs predominantly in children with acute lymphoblastic leukemia, lymphoma, and sarcoma. Pathogenesis of thrombosis in children with cancer is multifactorial. Thrombosis develops due to a combination of the primary disease itself, chemotherapy and supportive care, associated complications, and inherited prothrombotic risk factors probably contributed to the development of thrombosis in these children. Mortality as a result of VTE is low, but both symptomatic and asymptomatic thrombosis cause significant morbidity to justify primary thromboprophylaxis in children with cancer. Identification of risk factors is important to develop predictive models to identify patients at highest risk of thrombosis. Due to variations in risk factors, these models should be tailored to treatment protocols and patient populations. Multicenter studies are needed to investigate which prophylactic strategies are effective and safe to prevent thrombosis in children with cancer.
在过去几十年中，由于诊断程序的改进和多模式治疗策略，癌症患儿的生存率显著提高，几乎达到了80%。因此，预防包括静脉血栓栓塞（VTE）在内的治疗相关并发症的死亡率和发病率变得越来越重要。VTE主要发生在急性淋巴细胞白血病、淋巴瘤和肉瘤患儿中。癌症患儿血栓形成的发病机制是多因素的。血栓形成是由于原发性疾病本身、化疗和支持治疗、相关并发症以及遗传性血栓形成风险因素共同作用的结果，这些因素可能促使这些患儿发生血栓形成。VTE导致的死亡率较低，但有症状和无症状的血栓形成都会导致严重的发病率，这使得对癌症患儿进行一级血栓预防具有合理性。识别风险因素对于开发预测模型以识别血栓形成风险最高的患者非常重要。由于风险因素存在差异，这些模型应根据治疗方案和患者群体进行定制。需要进行多中心研究，以调查哪些预防策略对预防癌症患儿血栓形成是有效且安全的。
