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Blood, 1 October 2006, Vol. 108, No. 7, pp. 2216-2222.
Prepublished online as a Blood First Edition Paper on June 27, 2006; DOI 10.1182/blood-2006-04-015511.
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HEMOSTASIS, THROMBOSIS, AND VASCULAR BIOLOGY
Thrombotic complications in childhood acute lymphoblastic leukemia: a meta-analysis of 17 prospective studies comprising 1752 pediatric patients
Vanesa Caruso,
Licia Iacoviello,
Augusto Di Castelnuovo,
Sergio Storti,
Guglielmo Mariani,
Giovanni de Gaetano, and
Maria Benedetta Donati
From the Laboratory of Genetic and Environmental Epidemiology, Research Laboratories, and Hematology-Oncology Unit, Centre for High Technology Research and Education in Biomedical Sciences, Catholic University, Campobasso, Division of Hematology, L'Aquila University, L'Aquila, Italy.
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.
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