Cerebral venous thrombosis in adult patients with acute lymphoblastic leukemia or lymphoblastic lymphoma during induction chemotherapy with l-asparaginase: The GRAALL experience
In: ISSN: 0361-8609, 2015
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Zugriff:
International audience ; Central nervous system (CNS) thrombotic events are a well-known complication of acute lymphoblastic leukemia (ALL) induction therapy, especially with treatments including l-asparaginase (l-ASP). Data on risk factors and clinical evolution is still lacking in adult patients. We report on the clinical evolution of 22 CNS venous thrombosis cases occurring in 708 adults treated for ALL or lymphoblastic lymphoma (LL) with the Group for Research on Adult Acute Lymphoblastic Leukemia (GRAALL)-induction protocol, which included eight L-ASP (6,000 IU/m2) infusions. The prevalence of CNS thrombosis was 3.1%. CNS thrombosis occurred after a median of 18 days (range: 11–31) when patients had received a median of three l-ASP injections (range: 2–7). Patients with CNS thrombosis exhibited a median antithrombin (AT) nadir of 47.5% (range: 36–67%) at Day 17 (range: D3–D28), and 95% of them exhibited AT levels lower than 60%. There were no evident increase in hereditary thrombotic risk factors prevalence, and thrombosis occurred despite heparin prophylaxis which was performed in 90% of patients. Acquired AT deficiency was frequently detected in patients with l-ASP-based therapy, and patients with CNS thrombosis received AT prophylaxis (45%) less frequently than patients without CNS thrombosis (83%), P = 0.0002). CNS thrombosis was lethal in 5% of patients, while 20% had persistent sequelae. One patient received all planned l-ASP infusions without recurrence of CNS thrombotic whereas l-ASP injections were discontinued in 20 patients during the management of thrombosis without a significant impact on overall survival (P = 0.4). Am. J. Hematol. 90:986–991, 2015. © 2015 Wiley Periodicals, Inc
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Cerebral venous thrombosis in adult patients with acute lymphoblastic leukemia or lymphoblastic lymphoma during induction chemotherapy with l-asparaginase: The GRAALL experience
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Autor/in / Beteiligte Person: | Couturier, Marie-Anne ; Huguet, Françoise ; Chevallier, Patrice ; Suarez, Felipe ; Thomas, Xavier ; Escoffre-Barbe, Martine ; Cacheux, Victoria ; Pignon, Jean-Michel ; Bonmati, Caroline ; Sanhes, Laurence ; Bories, Pierre ; Daguindau, Etienne ; Dorvaux, Véronique ; Reman, Oumedaly ; Frayfer, Jamile ; Orvain, Corentin ; Lhéritier, Véronique ; Ifrah, Norbert ; Dombret, Hervé ; Hunault-Berger, Mathilde ; Tanguy-Schmidt, Aline ; Hôpital Morvan Brest ; Laboratoire d'Hématologie Purpan ; Université Toulouse III - Paul Sabatier (UT3) ; Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse Toulouse -Hôpital Purpan Toulouse ; CHU Toulouse Toulouse ; Centre hospitalier universitaire de Nantes (CHU Nantes) ; Imagine - Institut des maladies génétiques (IMAGINE - U1163) ; Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM) ; Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL) ; Centre Léon Bérard Lyon -Université Claude Bernard Lyon 1 (UCBL) ; Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS) ; Hôpital Edouard Herriot CHU -, HCL ; Hospices Civils de Lyon (HCL) ; Service d'hématologie clinique ; Université de Rennes 1 (UR1) ; Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou ; Clermont-Ferrand, CHU ; Centre Hospitalier Dunkerque ; Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy) ; Hôpital de Perpignan ; Centre Hospitalier Saint Jean de Perpignan ; Hématologie, Service ; Strasbourg, CHU ; d'hématologie, Service ; Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon) ; Centre hospitalier régional Metz-Thionville (CHR Metz-Thionville) ; CHU Henri Mondor ; Centre Hospitalier de Meaux ; Centre Hospitalier Universitaire d'Angers (CHU Angers) ; PRES Université Nantes Angers Le Mans (UNAM) ; Lymphocyte et cancer ; IFR105-Institut National de la Santé et de la Recherche Médicale (INSERM) ; Saint-Louis, Hôpital ; Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP) ; Centre de Recherche en Cancérologie Nantes-Angers (CRCNA) ; PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM)-Hôtel-Dieu de Nantes-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Laennec-Centre National de la Recherche Scientifique (CNRS)-Faculté de Médecine d'Angers-Centre hospitalier universitaire de Nantes (CHU Nantes) |
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Zeitschrift: | ISSN: 0361-8609, 2015 |
Veröffentlichung: | HAL CCSD ; Wiley, 2015 |
Medientyp: | academicJournal |
DOI: | 10.1002/ajh.24130 |
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