Thrombosis risk in children with acute lymphoblastic leukimia during the therapy

E. Seregina¹, L. Zharikova², N. Trubina², M. Korsantiya², M. Gracheva², A. Poletaev², T. Vuimo², J. Rumyantseva², F. Ataullakhanov³, A. Karachunsky²

¹Dmitry Rogachev National Medical Research Center Of Pediatric Hematology, Oncology and Immunology, Moscow, Moskva, Russia, ²Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Moskva, Russia, ³Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Moskva, Russia

Abstract Number: PB0271

Meeting: ISTH 2022 Congress

Theme: Pediatrics » Thrombosis in Neonates and Children

Background: Thrombosis is a common complication in cancer patients. Сутекфд venous catheters (CVC), L-asparaginase, steroids, as well as the presence of inherited thrombophilic disorders, are known risk factors for thrombosis in children with acute lymphiblastic leukemia (ALL).

Aims: The aim was to identify the thrombosis risk-group in children with ALL.

Methods: The hemostasis status of 117 patients (74 boys, 43 girls, 1-17 yrs, median 5 yr) with ALL treated according to ALL-MB-2015 protocol was assessed using APTT, fibrinogen, ATIII, D-dimer levels, Thromboelastography(TEG), Thrombodynamics(TD), thrombomodulin(TM) and endothelin-1(ET-1) during the treatment.

Results: 58 patients (56%) had thrombotic complications during the treatment: 6% were symptomatic . TEG parameter R was mostly normal in 91% of points while MA were in hypocoagulation in 35% of patients due to low platelets count. Fibrinogen levels were decreased in nearly 50%. ATIII were decreased in 76%. TD clot growth rate revealed hypercoagulation in 81% while APPT was prolonged in 52%. D-dimer levels were increased in 36%. Multidirectional changes in different tests revealed the imbalance in procoagulation and anticoagulation systems. If patients had hypercagulation by clot growth rate and no D-dimer increases they had nearly 50% of thrombotic complictations despite ATIII levels. If patients had increased D-dimer levels the percentage of thrombosis was much lower (nearly 12%). This may be related to lysis system function: if it was damaged during the treatment there can’t be D-dimer levels increased and hypercoagulation leads to thrombosis. No patients with normal clot growth rate had thrombosis. There were high TM and ET-1 levels in thrombosis group that can prooved the endothelium dysfunction in ALL.

Conclusion(s): The lysis system may be damages during ALL treatment that can lead to thrombotic complications. Endothelium dysfunction was proved by high markers in thrombosis group. Lysis dysfunction and endothelium damage can help to reveal the thrombosis high-risk group in children with ALL.

To cite this abstract in AMA style:

Seregina E, Zharikova L, Trubina N, Korsantiya M, Gracheva M, Poletaev A, Vuimo T, Rumyantseva J, Ataullakhanov F, Karachunsky A. Thrombosis risk in children with acute lymphoblastic leukimia during the therapy [abstract]. https://abstracts.isth.org/abstract/thrombosis-risk-in-children-with-acute-lymphoblastic-leukimia-during-the-therapy/. Accessed October 1, 2023.

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