Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
Department of Data Science, Dana Farber Cancer Institute, Boston, MA, USA.
Blood Cancer J. 2024 Oct 31;14(1):191. doi: 10.1038/s41408-024-01178-5.
Asparaginase (ASP)-containing regimens for acute lymphoblastic leukemia (ALL) are associated with venous thromboembolism (VTE). We evaluated the prevalence, risk factors, role of prophylaxis and clinical impact of VTE among adolescents and young adult (AYA) patients (15-50 years) treated on Dana-Farber Cancer Institute (DFCI) ALL protocols. The 1- and 2-year cumulative incidence of VTE were 31.9% (95% CI: 27.0%, 36.9%) and 33.5% (95% CI: 28.5%, 38.5%) respectively, with most events occurring during ASP-based consolidation phase (68.6%). VTE was more frequent in patients with overweight/obese vs. normal BMI (39.2% vs. 29.0%, p = 0.048). In a 1-year landmark analysis, the 4-year overall survival was 91.5%, without difference between patients with vs. without VTE (93.8% vs. 90.0%, p = 0.93). Relapse and non-relapse mortality rates were also similar. Among patients treated at Dana-Farber/Harvard Cancer Center, cerebral sinus vein thrombosis occurred in 3.6% of patients (8.5% of VTE events) in comparison to pulmonary embolism (32.9%) and deep vein thromboses (58.6%, 24.4% line-associated). In a Cox regression model for VTE free-time, elevated BMI was associated with shorter VTE free-time (HR 1.94 [95% CI 1.13-3.35], p = 0.018), while low molecular weight heparin (LMWH) prophylaxis as time-varying covariate was not. In conclusion, we found that VTE was frequent in AYAs treated on DFCI ALL protocols but did not impact survival outcomes. Overweight/obese BMI increased risk for VTE.
含天冬酰胺酶（ASP）的急性淋巴细胞白血病（ALL）治疗方案与静脉血栓栓塞症（VTE）相关。我们评估了在丹娜-法伯癌症研究所（DFCI）ALL 方案治疗的青少年和年轻成人（AYA）患者（15-50 岁）中 VTE 的患病率、危险因素、预防作用和临床影响。VTE 的 1 年和 2 年累积发生率分别为 31.9%（95%CI：27.0%，36.9%）和 33.5%（95%CI：28.5%，38.5%），大多数事件发生在基于 ASP 的巩固阶段（68.6%）。超重/肥胖患者的 VTE 发生率高于正常 BMI 患者（39.2%比 29.0%，p=0.048）。在 1 年的里程碑分析中，4 年总生存率为 91.5%，VTE 患者与无 VTE 患者之间无差异（93.8%比 90.0%，p=0.93）。复发和非复发死亡率也相似。在丹娜-法伯/哈佛癌症中心治疗的患者中，脑静脉窦血栓形成占患者的 3.6%（VTE 事件的 8.5%），而肺栓塞占 32.9%，深静脉血栓形成占 58.6%，24.4%与导管相关。在 VTE 无事件时间的 Cox 回归模型中，升高的 BMI 与较短的 VTE 无事件时间相关（HR 1.94[95%CI 1.13-3.35]，p=0.018），而作为时变协变量的低分子肝素（LMWH）预防则不然。总之，我们发现，在 DFCI ALL 方案治疗的 AYA 中，VTE 较为常见，但对生存结局没有影响。超重/肥胖 BMI 增加了 VTE 的风险。
