Venous thromboembolism in children with acute lymphoblastic leukemia in China: a report from the Chinese Children's Cancer Group-ALL-2015.

Mengmeng Yin; Hongsheng Wang; Xianmin Guan; Ju Gao; Minghua Yang; Ningling Wang; Tianfeng Liu; Jingyan Tang; Alex W K Leung; Fen Zhou; Xuedong WU; Jie Huang; Hong LI; Shaoyan HU; Xin Tian; Hua Jiang; Jiaoyang Cai; Xiaowen Zhai; Shuhong Shen; Qun HU

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Venous thromboembolism in children with acute lymphoblastic leukemia in China: a report from the Chinese Children's Cancer Group-ALL-2015.

Author: Mengmeng YIN ¹ ; Hongsheng WANG ² ; Xianmin GUAN ³ ; Ju GAO ⁴ ; Minghua YANG ⁵ ; Ningling WANG ⁶ ; Tianfeng LIU ⁷ ; Jingyan TANG ⁸ ; Alex W K LEUNG ⁹ ; Fen ZHOU ¹⁰ ; Xuedong WU ¹¹ ; Jie HUANG ¹² ; Hong LI ¹³ ; Shaoyan HU ¹⁴ ; Xin TIAN ¹⁵ ; Hua JIANG ¹⁶ ; Jiaoyang CAI ⁸ ; Xiaowen ZHAI ¹⁷ ; Shuhong SHEN ¹⁸ ; Qun HU ¹⁹
Author Information

1. Department of Pediatrics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
2. Department of Hematology/Oncology, Children's Hospital of Fudan University, Shanghai, 201100, China.
3. Department of Hematology/Oncology, Chongqing Medical University Affiliated Children's Hospital, Chongqing, 400015, China.
4. Department of Pediatrics, Key Laboratory of Birth Defects and Related Disease of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.
5. Department of Pediatrics, Xiangya Hospital Central South University, Changsha, 410008, China.
6. Department of Pediatrics, Anhui Medical University Second Affiliated Hospital, Hefei, 230601, China.
7. State Key Laboratory of Experimental Hematology and Division of Pediatric Blood Diseases Center, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Tianjin, 300020, China.
8. Department of Hematology/Oncology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Key Laboratory of Pediatric Hematology & Oncology of China Ministry of Health, Shanghai, 200120, China.
9. Department of Pediatrics, Hong Kong Children's Hospital, The Chinese University of Hong Kong, Hong Kong SAR, 999077, China.
10. Department of Pediatrics, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
11. Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, 516006, China.
12. Department of Hematology/Oncology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
13. Department of Hematology/Oncology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China.
14. Department of Hematology/Oncology, Children's Hospital of Soochow University, Suzhou, 215002, China.
15. Department of Hematology/Oncology, Kunming Children's Hospital, Kunming, 650103, China.
16. Department of Hematology/Oncology, Guangzhou Women and Children's Medical Center, Guangzhou, 510620, China.
17. Department of Hematology/Oncology, Children's Hospital of Fudan University, Shanghai, 201100, China. zhaixiaowendy@163.com.
18. Department of Hematology/Oncology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Key Laboratory of Pediatric Hematology & Oncology of China Ministry of Health, Shanghai, 200120, China. shenshuhong@scmc.com.cn.
19. Department of Pediatrics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. qunhu2013@163.com.
Publication Type:Journal Article
Keywords: acute lymphoblastic leukemia; child; clinical characteristic; epidemiology; risk factor; venous thromboembolism
MeSH: Humans; Child; Venous Thromboembolism/etiology*; East Asian People; Precursor Cell Lymphoblastic Leukemia-Lymphoma/epidemiology*; Risk Factors; Thrombosis/chemically induced*; China/epidemiology*; Anticoagulants/adverse effects*; Recurrence
From: Frontiers of Medicine 2023;17(3):518-526
CountryChina
Language:English
Abstract: Venous thromboembolism (VTE) is a complication in children with acute lymphoblastic leukemia (ALL). The Chinese Children's Cancer Group-ALL-2015 protocol was carried out in China, and epidemiology, clinical characteristics, and risk factors associated with VTE were analyzed. We collected data on VTE in a multi-institutional clinical study of 7640 patients with ALL diagnosed in 20 hospitals from January 2015 to December 2019. First, VTE occurred in 159 (2.08%) patients, including 90 (56.6%) during induction therapy and 108 (67.92%) in the upper extremities. T-ALL had a 1.74-fold increased risk of VTE (95% CI 1.08-2.8, P = 0.022). Septicemia, as an adverse event of ALL treatment, can significantly promote the occurrence of VTE (P < 0.001). Catheter-related thrombosis (CRT) accounted for 75.47% (n = 120); and, symptomatic VTE, 58.49% (n = 93), which was more common in patients aged 12-18 years (P = 0.023), non-CRT patients (P < 0.001), or patients with cerebral thrombosis (P < 0.001). Of the patients with VTE treated with anticoagulation therapy (n = 147), 4.08% (n = 6) had bleeding. The VTE recurrence rate was 5.03% (n = 8). Patients with VTE treated by non-ultrasound-guided venous cannulation (P = 0.02), with residual thrombus (P = 0.006), or with short anticoagulation period (P = 0.026) had high recurrence rates. Thus, preventing repeated venous puncture and appropriately prolonged anticoagulation time can reduce the risk of VTE recurrence.