Risk of thrombosis in adult philadelphia-positive ALL treated with an asparaginase-free ALL regimen

Ruiqi Chen, Xing Liu, Arjun D. Law, Solaf Kanfar, Dawn Maze, Steven M. Chan, Vikas Gupta, Karen W. Yee, Mark D. Minden, Aaron D. Schimmer, Andre C. Schuh, Caroline J. McNamara, Tracy Murphy, Anna Xu, Umberto Falcone, Jack Seki, Hassan Sibai

Research output: Contribution to journalArticlepeer-review

Abstract

Background: venous thromboembolism (VTE) is a well-known complication in adults with acute lymphoblastic leukemia (ALL), especially in patients treated with asparaginase (ASNase)-including regiments. However, VTE risk in adult Philadelphia-positive ALL (Ph+ve ALL) patients treated with non-hyperCVAD chemotherapy is unclear. In this study, we examined VTE incidence in adult Ph+ve ALL patients treated with imatinib plus a pediatric-inspired asparaginase (ASNase)-free regimen modified from the Dana Farber Cancer Institute (DFCI) ALL protocol. Methods: a single centre retrospective review of Ph+ve ALL patients treated at Princess Margaret Cancer Center (PMCC) from 2008–2019 with imatinib plus modified DFCI protocol was conducted. Results: of the 123 patients included, 30 (24.3%) had at least 1 radiology confirmed VTE event from diagnosis to the end of maintenance therapy. 86.7% (26/30) of the VTE events occurred during active treatment. Of all VTE events, the majority (53.3%) were DVT and/or PE while another significant portion were catheter-related (40.0%). Major bleeding was observed in 1 patient on VTE treatment with low molecular weight heparin (LMWH). Conclusion: a high VTE incidence (24.3%) was observed in adults Ph+ve ALL patients treated with imatinib plus an ASNase-free modified DFCI pediatric ALL protocol, suggesting prophylactic anticoagulation should be considered for all adult Ph+ve ALL patients including those treated with ASNase-free regimens.

Original languageEnglish
Pages (from-to)128-137
Number of pages10
JournalCurrent Oncology
Volume28
Issue number1
DOIs
Publication statusPublished - Feb 2021

Keywords

  • Acute lymphoblastic leukemia
  • Cancer-related thrombosis
  • Philadelphia-positive acute leukemia
  • Treatment-related thrombosis
  • Venous thromboembolism

ASJC Scopus subject areas

  • Oncology

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