Abstract Number: LPB0076
Meeting: ISTH 2021 Congress
Background: Cerebral sinovenous thrombosis (CSVT) is a serious complication of acute lymphoblastic leukemia (ALL) therapy. Asparaginase (ASP), a cornerstone in ALL treatment, is associated with increased risk of CSVT. CSVT-related premature truncation of ASP may impact survival rates.
Aims: To explore
- incidence of ASP truncation after CSVT in ALL patients
- potential clinical and imaging factors predictive of ASP truncation
- CSVT sequelae
Methods: We included patients (1‒45 years, n=2400) treated according to the NOPHO ALL2008 protocol from 2008/7‒2018/10. Data were retrospectively collected from medical charts. Informed consent was obtained and the study was approved by the local ethics committees.
Results: We identified 45 patients with CSVT, corresponding to a prevalence of 1.9% (95%-CI:1.4‒2.5%). Patients with CSVT were older (33% adolescents/10‒17.9 years; 22% adults/≥18 years), and 22% had CNS leukemia at ALL diagnosis, compared with patients without thromboembolism (16%, 14% and 12%, respectively) (p<0.01). Three patients (7%) died due to CSVT.
Twenty-nine patients (66%) were re-exposed to ASP a median of 33 days after CSVT, all under anticoagulation cover. Thirty-four (83%) had ≥1 ASP dose omitted. Patients re-exposed and non-re-exposed had a median of 2 and 6 doses omitted, respectively. Two patients (4%) experienced re-thrombosis after ASP re-exposure. No re-thrombosis among non-re-exposed patients. Re-exposed patients performed better on the Modified Rankin Scale (mRS) compared to non-re-exposed (2.0 versus 2.7, p<0.05) at CSVT diagnosis. No neurological findings predicted re-exposure. CSVT-score by Zubkov AY et al. quantifying CSVT extension showed no difference among re-exposed and non-re-exposed patients at CSVT diagnosis (2.3 versus 2.9, p=0.16) nor at last follow-up (0.6 versus 0.8, p=0.21). No difference was detected applying mRS among re- and non-re-exposed patients (0.38 and 0.45, p=0.08) at last follow-up (mean 5.8 years).
Conclusions: Although 66% of ALL patients diagnosed with CSVT were re-exposed to ASP, a low recurrence of thrombosis (4%) was detected.
To cite this abstract in AMA style:Skipper MT, Rank CU, Andrés-Jensen L, Schmiegelow K, Albertsen BK, Tuckuviene R, NOPHO Thrombosis and Haemostasis Working group . Cerebral Sinovenous Thrombosis and Asparaginase Re-exposure in Patients Aged 1 to 45 Years with Acute Lymphoblastic Leukemia: A NOPHO ALL2008 Study [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/cerebral-sinovenous-thrombosis-and-asparaginase-re-exposure-in-patients-aged-1-to-45-years-with-acute-lymphoblastic-leukemia-a-nopho-all2008-study/. Accessed December 7, 2021.
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