费城染色体阳性成人 ALL 患者应用无门冬酰胺酶 ALL 方案治疗的血栓风险。
Risk of Thrombosis in Adult Philadelphia-Positive ALL Treated with an Asparaginase-Free ALL Regimen.
机构信息
Princess Margaret Cancer Centre, Department of Medical Oncology and Hematology, University Health Network, Toronto, ON M5G 2C1, Canada.
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada.
出版信息
Curr Oncol. 2020 Dec 22;28(1):128-137. doi: 10.3390/curroncol28010016.
BACKGROUND
venous thromboembolism (VTE) is a well-known complication in adults with acute lymphoblastic leukemia (ALL), especially in patients treated with asparaginase (ASNase)-including regiments. However, VTE risk in adult Philadelphia-positive ALL (Ph+ve ALL) patients treated with non-hyperCVAD chemotherapy is unclear. In this study, we examined VTE incidence in adult Ph+ve ALL patients treated with imatinib plus a pediatric-inspired asparaginase (ASNase)-free regimen modified from the Dana Farber Cancer Institute (DFCI) ALL protocol.
METHODS
a single centre retrospective review of Ph+ve ALL patients treated at Princess Margaret Cancer Center (PMCC) from 2008-2019 with imatinib plus modified DFCI protocol was conducted.
RESULTS
of the 123 patients included, 30 (24.3%) had at least 1 radiology confirmed VTE event from diagnosis to the end of maintenance therapy. 86.7% (26/30) of the VTE events occurred during active treatment. Of all VTE events, the majority (53.3%) were DVT and/or PE while another significant portion were catheter-related (40.0%). Major bleeding was observed in 1 patient on VTE treatment with low molecular weight heparin (LMWH).
CONCLUSION
a high VTE incidence (24.3%) was observed in adults Ph+ve ALL patients treated with imatinib plus an ASNase-free modified DFCI pediatric ALL protocol, suggesting prophylactic anticoagulation should be considered for all adult Ph+ve ALL patients including those treated with ASNase-free regimens.
背景
静脉血栓栓塞症（VTE）是急性淋巴细胞白血病（ALL）成人患者的一种众所周知的并发症，尤其是在接受包含天冬酰胺酶（ASNase）的治疗方案的患者中。然而，在接受非高剂量环磷酰胺、长春新碱、多柔比星和地塞米松（hyperCVAD）化疗的成人费城染色体阳性 ALL（Ph+ve ALL）患者中，VTE 的风险尚不清楚。在这项研究中，我们检查了接受伊马替尼联合从 Dana-Farber 癌症研究所（DFCI）ALL 方案修改而来的不含 ASNase 的儿科启发式方案治疗的成人 Ph+ve ALL 患者的 VTE 发生率。
方法
对 2008 年至 2019 年在玛格丽特公主癌症中心（PMCC）接受伊马替尼联合改良 DFCI 方案治疗的 Ph+ve ALL 患者进行了单中心回顾性研究。
结果
在纳入的 123 例患者中，有 30 例（24.3%）在诊断至维持治疗结束期间至少有 1 次影像学证实的 VTE 事件。86.7%（26/30）的 VTE 事件发生在治疗期间。所有 VTE 事件中，大多数（53.3%）为 DVT 和/或 PE，另一部分为导管相关（40.0%）。1 例接受 VTE 治疗（低分子肝素[LMWH]）的患者出现大出血。
结论
在接受伊马替尼联合不含 ASNase 的改良 DFCI 儿科 ALL 方案治疗的成人 Ph+ve ALL 患者中，观察到高 VTE 发生率（24.3%），提示应考虑预防性抗凝治疗所有成人 Ph+ve ALL 患者，包括接受无 ASNase 方案治疗的患者。
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