Title Pulmonary embolism in acute lymphoblastic leukemia - An observational study of 1685 patients treated according to the NOPHO ALL2008 protocol /
Authors Tuckuviene, Ruta ; Bjerg, Cecilie Lundgaard ; Jonsson, Olafur Gisli ; Langstrom, Satu ; Rank, Cecilie Utke ; Ranta, Susanna ; Saks, Kadri ; Šaulytė Trakymienė, Sonata ; Ruud, Ellen
DOI 10.1002/rth2.12356
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Is Part of Research and practice in thrombosis and haemostasis.. Hoboken : Wiley. 2020, vol. 4, iss. 5, p. 866-871.. eISSN 2475-0379
Keywords [eng] acute lymphoblastic leukemia ; asparaginase ; incidence ; pulmonary embolism ; toxicity
Abstract [eng] Background: Pulmonary embolism (PE) is a serious complication of acute lymphoblastic leukemia (ALL). We examined the cumulative incidence and clinical presentation of PE in a well-defined cohort of patients with ALL aged 1-45 years treated according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL2008 protocol. Methods: As part of the mandatory toxicity reporting of NOPHO ALL2008, thromboembolism including PE was reported consecutively. The cumulative incidence of first-time PE was calculated using the Aalen-Johansen estimator during a 2.5-year period from ALL diagnosis. We used Fisher's exact test to examine categorical variables and Cox logistic regression to estimate hazard ratios (HRs) for PE. Results: PE was diagnosed in 32 of 1685 patients. The 2.5-year cumulative incidence of first-time PE increased with age: 0.43% (95% CI, 0.18-1.03) in children aged 1-9 years, 3.28% (95% CI, 1.72-6.22) in children aged 10-17 years, and 7.22% (95% CI, 4.61-11.21) in adults aged 18-45 years. The majority of PEs, 78% (25/32), occurred during asparaginase treatment. HRs adjusted for age and sex were associated with male sex (HR, 2.4; 95% CI, 1.0-5.6) and older age (10-17 years: HR 7.5; 95% CI, 2.5-22.2), 18-45 years: HR, 16.5; 95% CI, 6.1-44.5). In two-thirds of the patients (63%; 17/27), PE and its treatment had no impact on the administered doses of asparaginase. PE-associated 30-day mortality was 9.4% (95% CI, 1.9-25.0). Conclusions: Awareness of PE is warranted during ALL treatment. Larger multicenter studies are needed to examine predictors of PE in ALL.
Published Hoboken : Wiley
Type Journal article
Language English
Publication date 2020
CC license CC license description