Low plasma levels of hemostatic proteins during the induction phase in children with acute lymphoblastic leukemia: A retrospective study by the JACLS

Hongo, Teruaki; Okada, Shuichi; Ohzeki, Takehiko; Ohta, Hiroyuki; Nishimura, Shin‐Ichiro; Hamamoto, Kazuko; Yagi, Keiko; Misu, Hideo; Eguchi, Naohiro; Suzuki, Nobuhiro; Horibe, Keizo; Ueda, Kazuhiro

doi:10.1046/j.1442-200x.2002.01556.x

Cited by 40 publications

(25 citation statements)

References 20 publications

(23 reference statements)

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“…Most of the hemorrhagic manifestations that occurred during induction therapy for ALL were mild, as previously reported. 16 On the other hand, no increase in the incidence of bleeding was observed in patients with Fg levels lower than 0.5 g/L. However, FFP and Fg concentrates were frequently infused and this possibly reduced the risk of hemorrhage.…”

Section: Discussionmentioning

confidence: 96%

Changes in antithrombin and fibrinogen levels during induction chemotherapy with L-asparaginase in adult patients with acute lymphoblastic leukemia or lymphoblastic lymphoma. Use of supportive coagulation therapy and clinical outcome: the CAPELAL study

Hunault¹,

Chevallier²,

Delain³

et al. 2008

Haematologica

130

106

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Section: Discussionmentioning

confidence: 96%

Changes in antithrombin and fibrinogen levels during induction chemotherapy with L-asparaginase in adult patients with acute lymphoblastic leukemia or lymphoblastic lymphoma. Use of supportive coagulation therapy and clinical outcome: the CAPELAL study

Hunault¹,

Chevallier²,

Delain³

et al. 2008

Haematologica

130

106

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“…About three quarters of the subjects (74%) were included in retrospective studies. [96][97][98][99][100][101][102] In this group, the incidence rate (IR) of thrombotic events was lower than that observed in prospective studies ( Table 1). As recalling of events in retrospective studies is rather erratic and prospective design constitutes the best way to observe the frequency of a phenomenon, only prospective studies were considered for subsequent analyses.…”

Section: Selection Of Articlesmentioning

confidence: 89%

Thrombotic complications in childhood acute lymphoblastic leukemia: a meta-analysis of 17 prospective studies comprising 1752 pediatric patients

Caruso

Iacoviello

Castelnuovo

et al. 2006

Blood

336

350

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The risk of thrombosis in children with acute lymphoblastic leukemia (ALL) reportedly ranges between 1% and 37%. Epidemiologic studies have usually been hampered by small numbers, making accurate estimates of thrombosis risk in ALL patients very difficult. The aim of this study was to better estimate the frequency of this complication and to define how the disease, its treatment, and the host contribute to its occurrence. We made an attempt to combine and analyze all published data on the association between pediatric ALL and thrombosis, by using a meta-analytic method. The rate of thrombosis in 1752 children from 17 prospective studies was 5.2% (95% CI: 4.2-6.4). The risk varies depending on several factors. Most of the events occurred during the induction phase of therapy. Lower doses of asparaginase (ASP) for long periods were associated with the highest incidence of thrombosis, as were anthracyclines and prednisone (instead of dexamethasone). The presence of central lines and of thrombophilic genetic abnormalities also appeared to be frequently associated with thrombosis. In conclusion, the overall thrombotic risk in ALL children was significant, and the subgroup analysis was able to identify high-risk individuals, a finding that will hopefully guide future prospective studies aimed at decreasing this risk. IntroductionAcute lymphoblastic leukemia (ALL) is more frequent in children than in adults; indeed, two thirds of all cases occur at pediatric age. 1 The risk of thrombosis is increased in ALL patients, 2 and its occurrence may complicate the treatment course with a negative prognostic impact. Its frequency reportedly ranges between 1.1% and 36.7%, a quite large variation related to several factors, such as different definitions of thrombosis (symptomatic vs asymptomatic), diagnostic methods for its detection, study design (prospective vs retrospective), and differences in treatment protocols. 2 The pathogenesis of this increased thrombotic risk is not fully understood, but includes a combination of variables related to the disease itself, its treatment, and the host. [3][4][5] Although many clinical and epidemiologic studies were performed in this field, the majority were either retrospective or prospective observations on small numbers of subjects. Thus, the results are contradictory and inconclusive, mainly due to lack of statistical power. However, a careful assessment of risk factors would be useful to improve the quality of treatment and to identify subgroups in which prophylactic interventions would be beneficial.The objective of the present study was to quantitatively combine and analyze the available data, by a meta-analytic approach, to obtain accurate estimates of the thrombotic risk in pediatric patients with ALL.Several subgroup analyses were carried out to control for possible biases arising from heterogeneous pieces of information and to sort out subpopulations at higher risk of thrombosis. Materials and methods Meta-analysisIn the PubMed database, all available articles were searched usin...

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“…In contrast, other reports have suggested the significance of serum fibrinogen level. 11,[25][26][27][28][29][30] Most of these reports, however, concentrated on patients with DIC or APL. In our patient population, serum fibrinogen concentration did not correlate well with FICH, perhaps owing to its varied etiologies.…”

Section: Discussionmentioning

confidence: 99%

Risk score model for fatal intracranial hemorrhage in acute leukemia

Kim

et al. 2006

Leukemia

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To build a risk score (RS) model of fatal intracranial hemorrhage (FICH) in patients with acute leukemia, we retrospectively assessed risk factors in 792 patients newly diagnosed with acute leukemia, 41 of whom had analyzable FICH. We found that female gender (relative risk (RR) ¼ 5.234, Po0.001), acute promyelocytic leukemia (RR ¼ 4.057, P ¼ 0.003), leukocytosis (RR ¼ 3.301, P ¼ 0.004), thrombocytopenia (RR ¼ 3.283, P ¼ 0.005) and prolonged prothrombin time (RR ¼ 3.291, P ¼ 0.016) were significantly associated with occurrence of FICH in multivariate analysis. To calculate RS for FICH, one point was assigned for each risk factor, making the RS between 0 and 5. The RS model segregated patients into three prognostic groups: a low-risk group (LRG) for RS of 0 or 1; an intermediate-risk group (IRG) for RS of 2 or 3; and a high-risk group (HRG) for RS of 4 or 5. Expectation of FICH was well correlated with risk groups (all P-values o0.001). Overall survival was significantly shorter in the HRG compared with the LRG. The RS model we constructed to predict the occurrence of FICH will be verified through prospective studies.

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Low plasma levels of hemostatic proteins during the induction phase in children with acute lymphoblastic leukemia: A retrospective study by the JACLS

Cited by 40 publications

References 20 publications

Changes in antithrombin and fibrinogen levels during induction chemotherapy with L-asparaginase in adult patients with acute lymphoblastic leukemia or lymphoblastic lymphoma. Use of supportive coagulation therapy and clinical outcome: the CAPELAL study

Changes in antithrombin and fibrinogen levels during induction chemotherapy with L-asparaginase in adult patients with acute lymphoblastic leukemia or lymphoblastic lymphoma. Use of supportive coagulation therapy and clinical outcome: the CAPELAL study

Thrombotic complications in childhood acute lymphoblastic leukemia: a meta-analysis of 17 prospective studies comprising 1752 pediatric patients

Risk score model for fatal intracranial hemorrhage in acute leukemia

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