文章：

接受儿科启发方案治疗的青少年和年轻成人急性淋巴细胞白血病的静脉血栓栓塞

Venous thromboembolism in adolescents and young adults with acute lymphoblastic leukemia treated on a pediatric-inspired regimen

原文发布日期：2024-10-31

DOI: 10.1038/s41408-024-01178-5

类型: Article

开放获取: 是

英文摘要：

Asparaginase (ASP)-containing regimens for acute lymphoblastic leukemia (ALL) are associated with venous thromboembolism (VTE). We evaluated the prevalence, risk factors, role of prophylaxis and clinical impact of VTE among adolescents and young adult (AYA) patients (15–50 years) treated on Dana-Farber Cancer Institute (DFCI) ALL protocols. The 1- and 2-year cumulative incidence of VTE were 31.9% (95% CI: 27.0%, 36.9%) and 33.5% (95% CI: 28.5%, 38.5%) respectively, with most events occurring during ASP-based consolidation phase (68.6%). VTE was more frequent in patients with overweight/obese vs. normal BMI (39.2% vs. 29.0%, p = 0.048). In a 1-year landmark analysis, the 4-year overall survival was 91.5%, without difference between patients with vs. without VTE (93.8% vs. 90.0%, p = 0.93). Relapse and non-relapse mortality rates were also similar. Among patients treated at Dana-Farber/Harvard Cancer Center, cerebral sinus vein thrombosis occurred in 3.6% of patients (8.5% of VTE events) in comparison to pulmonary embolism (32.9%) and deep vein thromboses (58.6%, 24.4% line-associated). In a Cox regression model for VTE free-time, elevated BMI was associated with shorter VTE free-time (HR 1.94 [95% CI 1.13-3.35], p = 0.018), while low molecular weight heparin (LMWH) prophylaxis as time-varying covariate was not. In conclusion, we found that VTE was frequent in AYAs treated on DFCI ALL protocols but did not impact survival outcomes. Overweight/obese BMI increased risk for VTE.
 

摘要翻译： 

含有门冬酰胺酶（ASP）的急性淋巴细胞白血病（ALL）治疗方案与静脉血栓栓塞（VTE）的发生相关。我们在丹娜-法伯癌症研究所（DFCI）ALL方案治疗的青少年和年轻成人（AYA）患者（15-50岁）中评估了VTE的患病率、危险因素、预防措施的作用及其临床影响。VTE的1年和2年累积发生率分别为31.9%（95% CI：27.0%，36.9%）和33.5%（95% CI：28.5%，38.5%），大多数事件发生在基于门冬酰胺酶的巩固治疗阶段（68.6%）。超重/肥胖患者相较于体重指数（BMI）正常者VTE发生率更高（39.2% vs. 29.0%，p=0.048）。在1年界标分析中，4年总生存率为91.5%，有无VTE的患者之间无差异（93.8% vs. 90.0%，p=0.93）。复发率和非复发死亡率也相似。在丹娜-法伯/哈佛癌症中心治疗的患者中，脑静脉窦血栓发生率为3.6%（占VTE事件的8.5%），而肺栓塞和深静脉血栓发生率分别为32.9%和58.6%（其中24.4%为导管相关）。在VTE无事件时间的Cox回归模型中，BMI升高与更短的VTE无事件时间相关（HR 1.94 [95% CI 1.13-3.35]，p=0.018），而以时变协变量分析的低分子肝素（LMWH）预防则无显著关联。总之，我们发现接受DFCI ALL方案治疗的AYA患者中VTE发生频繁，但未影响生存结局。超重/肥胖的BMI会增加VTE风险。

原文链接：

Venous thromboembolism in adolescents and young adults with acute lymphoblastic leukemia treated on a pediatric-inspired regimen