The impact of prophylactic fresh-frozen plasma and cryoprecipitate on the incidence of central nervous system thrombosis and hemorrhage in children with acute lymphoblastic leukemia receiving asparaginase.
Asparaginase (ASP) therapy is associated with depletion of antithrombin (AT) and fibrinogen (FG). Potential toxicities include central nervous system thrombosis (CNST) and hemorrhage. Historical practice at the Izaak Walton Killam Health Centre (IWK) involves measuring AT and FG levels after ASP administration and transfusing fresh-frozen plasma (FFP) or cryoprecipitate (CRY) to prevent thrombotic and hemorrhagic complications. To determine whether this reduced these complications in children with acute lymphoblastic leukemia (ALL), incidence, outcome, and clinical characteristics of ASP-related CNST in ALL patients at IWK were compared with a similar cohort from BC Children's Hospital (BCCH), where prophylaxis was not performed. Costs associated with preventative versus expectant management were estimated. From 1990 to 2005, 240 patients were treated at IWK and 479 at BCCH. Seven BCCH patients developed venous CNST (1.5%), compared with none at IWK. CNST occurred exclusively during induction. Six patients received anticoagulation and continued ASP. All 7 patients remain in remission. National Cancer Institute high-risk ALL predicted CNST risk (P = .02), whereas sex, age, race, and body mass index did not. Neither FFP nor CRY protected against CNST, suggesting prophylaxis is unwarranted for unselected ALL patients. However, prophylactic replacement for HR patients in induction may be cost-effective.
Abbott
Lesleigh S
LS
Department of Pediatrics, Dalhousie University and Isaak Walton Killam Health Centre, Halifax, NS, Canada.
Deevska
Mariana
M
Fernandez
Conrad V
CV
Dix
David
D
Price
Victoria E
VE
Wang
Hao
H
Parker
Louise
L
Yhap
Margaret
M
Fitzgerald
Colleen
C
Barnard
Dorothy R
DR
Berman
Jason N
JN
D000293:Adolescent; D001215:Asparaginase / Q000009:adverse effects / Q000627:therapeutic use*; D001955:British Columbia; D002490:Central Nervous System / Q000098:blood supply; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D005169:Factor VIII / Q000627:therapeutic use*; D005260:Female; D005340:Fibrinogen / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D008297:Male; D009674:Nova Scotia; D017063:Outcome Assessment, Health Care / Q000191:economics; D010949:Plasma; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000191:economics; D012074:Remission Induction; D012737:Sex Factors; D013927:Thrombosis / Q000139:chemically induced / Q000517:prevention & control*
C026912:cryoprecipitate coagulum; D005169:Factor VIII; D005340:Fibrinogen; D001215:Asparaginase