Venous thromboembolism prevention during asparaginase-based therapy for acute lymphoblastic leukemia

H. Sibai, J.T. Seki, T.Q. Wang, N. Sakurai, E.G. Atenafu, K.W.L. Yee, A.C. Schuh, V. Gupta, M.D. Minden, A.D. Schimmer, J.M. Brandwein

Abstract


Background

Venous thromboembolism (vte) is a recognized complication in patients treated with asparaginase containing chemotherapy regimens; the optimal preventive strategy is unclear. We assessed the safety and efficacy of prophylaxis using low-dose low molecular weight heparin in adult patients with acute lymphoblastic leukemia in complete remission treated with an asparaginase-based post-remission chemotherapy regimen.

Methods

As part of the intensification phase of the Dana-Farber Cancer Institute 91-01 regimen, asparaginase was administered weekly to 41 consecutive patients for 21–30 weeks; these patients also received prophylaxis with enoxaparin 40 mg daily (60 mg for patients ≥80 kg). Outcomes were assessed against outcomes in a comparable cohort of 99 patients who received the same chemotherapy regimen without anticoagulation prophylaxis.

Results

The overall rate of symptomatic venous thrombosis was not significantly different in the prophylaxis and non-prophylaxis cohorts (18.92% and 21.74% respectively). Among patients receiving prophylaxis, vte occurred in higher proportion in those who weighed at least 80 kg (42.86% vs. 4.35%, p = 0.0070). No major bleeding complications occurred in the prophylaxis group (minor bleeding: 8.1%).

Conclusions

Prophylaxis with low-dose enoxaparin during the intensification phase was safe, but was not associated with a lower overall proportion of vte.


Keywords


Anticoagulants; asparaginase; leukemia; venous thromboembolism; prophylaxis

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DOI: http://dx.doi.org/10.3747/co.23.3077






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ISSN: 1198-0052 (Print) ISSN: 1718-7729 (Online)