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Risk factors of central venous lines-related thrombosis in children with acute lymphoblastic leukemia during induction therapy: a prospective study

Leukemia volume 21, pages 552–556 (2007)Cite this article

Children with acute lymphoblastic leukemia (ALL), who have central venous lines (CVL) early inserted during induction therapy including steroid and Escherichia coli L-asparaginase (L-Asp), are at high risk of developing CVL venous thrombosis (CVL-VT).1, 2, 3 Data on occurrence, risk factors and outcome of CVL-VT, as well as the gold-standard imaging test, are either limited or controversial.1, 2, 3, 4 A recent meta-analysis on thrombotic events in childhood ALL could not thoroughly evaluated the role of CVL as the proportion of patients bearing a CVL was reported by few prospective studies.4 Recognizing the risk factors of CVL-related complications is important for assessing the benefit/risk ratio of these devices.

We prospectively evaluated the occurrence and risk factors of CVL-VT detected by spiral computed tomography (CT) and ultrasound (US) in 70 consecutive children with ALL, who had CVL inserted within 2 weeks from starting chemotherapy. The induction therapy included steroid (4 weeks), vincristine and daunorubicin (4 doses, weekly), E. coli L-Asp (eight doses of 5000 UI/m2, every 3 days) and intrathecal (IT) chemotherapy, followed by 6-mercaptopurine, cytarabine, cyclophosphamide and IT chemotherapy. From January to August 2000 patients were enroled in the Associazione Italiana di Emato-Oncologia Pediatrica (AIEOP) ALL 95 study, thereafter in the AIEOP ALL 2000. The major differences between the two studies were randomization to PDN or dexamethazone (DXM) until day +28 in the ALL 2000 protocol, L-Asp starting from day +19 in the ALL 95 versus from day +12 in the ALL 2000 protocol, and triple IT chemotherapy (methotrexate, cytarabine and hydrocortisone) in ALL 95 versus only IT methotrexate in ALL 2000.

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Acknowledgements

We thank the Onco–Hematology nursing staff for caring the patients, Carla Alliaudi for thrombophilia analysis and Roberto Calabrese for statistical analysis. This study was partially supported by grants from Banca del Piemonte and Regione Piemonte, N 714/2004.

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Authors and Affiliations

  1. Department of Pediatric Onco-Hematology and Immunology, University of Torino, Torino, Italy

    L Farinasso, N Bertorello, L Garbarini, E Barisone, M Giacchino & P Saracco

  2. Department of Radiology and Neuroradiology, Azienda Ospedaliera OIRM-S.Anna, Torino, Italy

    T M Gajno & L Artesani

  3. Department of Cardiology and Cardiosurgery, Azienda Ospedaliera OIRM-S.Anna, Torino, Italy

    A Valori

  4. Division of Pediatrics, Department of Medical Sciences, University of Piemonte Orientale, Novara, Italy. E-mail: paola.saracco@unito.it,

    G Pastore

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  1. L Farinasso
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Farinasso, L., Bertorello, N., Garbarini, L. et al. Risk factors of central venous lines-related thrombosis in children with acute lymphoblastic leukemia during induction therapy: a prospective study. Leukemia 21, 552–556 (2007). https://doi.org/10.1038/sj.leu.2404560

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