OC 08.3 - Venous thromboembolism in a large series of pediatric patients with acute lymphoblastic leukemia. Risk factors and use of prophylaxis.

Saturday, July 9, 2022

1:30 PM – 1:45 PM

Location: ExCel Center, ICC Capital Suite Room 17

Presentation Format: In-Person

Presenting Author(s)

Rubén Berrueco, PhD

Head of Department. Pediatric Hematology
Hospital Sant Joan de Déu
Esplugues Llobregat, Catalonia, Spain

Co-Author(s)

AR

Anna Ruiz-Llobet

Pediatric Hematologist
Sant Joan de Déu Hospital
Eplugues de Llobregat, Catalonia, Spain
SG

Susanna Gassiot

Head of Laboratory of Hematology Department
Sant Joan de Déu Hospital
Esplugues de Llobregat, Catalonia, Spain
ES

Edurne Sarrate

Laboratory of hematology
Sant Joan de Déu Hospital
Esplugues de Llobregat, Ceuta, Spain
JZ

Josune Zubicaray

Pediatric Hematologist
Hospital Universitario Niño Jesús
Madrid, Madrid, Spain
JD

José Luis Dapena

Pediatric Hemato-oncologist
Hospital Sant Joan de Déu
Barcelona, Catalonia, Spain
AM

Angela Menárguez

Pediatra residente
Hospital Universitario Vall d'Hebrón
Barcelona, Catalonia, Spain
MP

Melissa Panesso

Pediatra residente
Hospital Universitario Vall d'Hebrón
Barcelona, Catalonia, Spain
CM

Catalina Montoya

Pediatra. Hemato-oncología
Hospital de Alicante
Alicante, Comunidad Valenciana, Spain
JV

Jose Manuel Vagace

Hematología y Hemoterapia
Complejo Hospitalario Universitario de Badajoz.
Badajoz, Extremadura, Spain
JM

José Ramón Molina

Hematología y Hemoterapia
Hospital Universitario Reina Sofía
Córdoba, Andalucia, Spain
MG

Marina García-Morín

Hematología y Oncología Pediátricas
Hospital Gregorio Marañón
Madrid, Madrid, Spain
MG

Miriam García-Abos

10. Servicio de Oncología Pediátrica.
Hospital Universitario Donostia
Donostia, Pais Vasco, Spain
MM

María Carmen Mendoza

Hematología
Hospital Universitario de Salamanca
Salamanca, Castilla y Leon, Spain
FL

Francisco Lendinez

Pediatría
Hospital Torrecárdenas
Almería, Andalucia, Spain
PP

Pilar Palomo

Hematología pediátrica
Hospital Universitario Central de Asturias
Oviedo, Asturias, Spain
MT

María Tallón

Pediatría
Hospital Álvaro Cunquerio Vigo
Vigo, Galicia, Spain
BG

Berta González

Hematología y Oncología Pediátricas
Hospital Universitario La Paz
Madrid, Madrid, Spain
EU

Emilia Urrutia

Hematología y oncología pediátricas
Hospital Materno Infantil Virgen de las Nieves
Granada, Andalucia, Spain
JS

José Vicente Serna

Pediatría
Hospital Sant Pau i la Santa Creu
Barcelona, Catalonia, Spain

Background: Symptomatic venous thromboembolism (VTE) is diagnosed in 3-14% of patients during pediatric acute lymphoblastic leukemia (ALL) therapy. There are well-known risk factors, but the role of others as inherited thrombophilia is still controversial. Prophylaxis with low molecular weight heparin (LMWH) has been described, but its use is not globally accepted.

Aims: To evaluate VTE rate and VTE risk factors in ALL patients treated following the same protocol, and safety and effectiveness of LMWH administration as thromboprophylaxis in children with inherited thrombophilia.

Methods: A retrospective multicentric study in ALL patients 1-18 years old following SEHOP-PETHEMA-2013 treatment guideline was performed to evaluate VTE rate, anticoagulant treatment, outcome, risk factors, and safety and usefulness of LMWH administration as primary thromboprophylaxis in children with inherited thrombophilia.

Results: A total of 652 patients were included in the study. VTE incidence was 8.7%. Most of the cases occurred during induction therapy, associated to central venous catheter. Univariant analysis showed that family history of thrombosis, presence of mediastinal mass, high-risk treatment group and inherited thrombophilia were statistically significant risk factors. Inherited thrombophilia was also an independent risk VTE factor in multivariate analysis (figure 1). LMWH administration was related to a decrease of VTE in patients with inherited thrombophilia and those with T-ALL phenotype.

Conclusion(s): Most of VTE cases occurred in patients without inherited thrombophilia, but when it is present, VTE risk is higher. LMWH administration was useful to decrease VTE in these patients.