Abstract
Background Venous thromboembolism (VTE) is an important complication for treatment of acute
lymphoblastic leukemia (ALL) in children. Especially, ALL treatment, with therapeutics
such as asparaginase and steroids, increases the thrombotic risk by reduction in procoagulant
and anticoagulant proteins. Replacement of deficient natural anticoagulants by administration
of fresh frozen plasma (FFP) may have a preventive effect on the occurrence of VTE.
Methods We retrospectively analyzed all consecutive children (≤18 years) with ALL, treated
on the Dutch Childhood Oncology Group (DCOG) ALL-9 and ALL-10 protocols at the Emma
Children's Hospital Academic Medical Center between February 1997 and January 2012,
to study the effect of FFP on VTE incidence, antithrombin and fibrinogen plasma levels,
and VTE risk factors.
Results In total, 18/205 patients developed VTE (8.8%; 95% confidence interval [CI]: 4.9–12.7%).
In all patients, VTE occurred after asparaginase administration. In total, 82/205
patients (40%) received FFP. FFP supplementation did not prevent VTE or alter plasma
levels of antithrombin or fibrinogen. In the multivariate analysis, VTE occurred significantly
more frequently in children ≥12 years (odds ratio [OR]: 3.89; 95% CI: 1.29–11.73)
and treated according to the ALL-10 protocol (OR: 3.71; 95% CI: 1.13–12.17).
Conclusion FFP supplementation does not seem to be beneficial in the prevention of VTE in pediatric
ALL patients. In addition, age ≥12 years and treatment according to the DCOG ALL-10
protocol with intensive and prolonged administration of asparaginase in combination
with prednisone are risk factors. There is a need for effective preventive strategies
in ALL patients at high risk for VTE.
Keywords
Acute lymphoblastic leukemia - fresh frozen plasma - pediatric - risk factors - venous
thromboembolism
