Clinical Course of Cerebral Venous Thrombosis in Adult Acute Lymphoblastic Leukemia.
BACKGROUND
Venous thromboembolism (VTE) is a frequent complication in patients with acute lymphoblastic leukemia (ALL). A significant proportion of patients develop cerebral venous thrombosis (CVT).


METHODS
To investigate risk factors for and the clinical course of CVT in ALL patients, we describe all cases of CVT which occurred in a well-defined cohort of 240 adults, treated for newly diagnosed ALL in the HOVON (Dutch-Belgian Hemato-Oncology Cooperative Group)-37 study. We conducted a nested case-control study to explore the relevance of early symptoms and risk factors for CVT in ALL patients.


RESULTS
Nine of 240 patients developed CVT (4%). CVT occurred during or shortly after L-asparaginase therapy (in 8 cases) and shortly after intrathecal methotrexate injections (in all cases) during cycle I of remission induction treatment. CVT was associated with prior headache and seizures. In 5 of 9 patients with CVT, headache before the diagnosis of CVT occurred within 3 days after lumbar puncture and initially had a postural character.


CONCLUSIONS
CVT is relatively common in adult ALL patients. Our data suggest that CVT in adult ALL patients results from the additive effects of multiple risk factors, with a particular role for asparaginase and the effects of lumbar punctures for intrathecal therapy.
Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands.
Susanna M
SM
Zuurbier
Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands; Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands.
Mandy N
MN
Lauw
Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: j.coutinho@amc.uva.nl.
Jonathan M
JM
Coutinho
Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
Charles B L M
CB
Majoie
HOVON Data Centre, Erasmus MC Cancer Institute-Clinical Trial Centre, Rotterdam, The Netherlands.
Bronno
B
van der Holt
Department of Hematology, Erasmus MC-Daniel den Hoed, Rotterdam, The Netherlands.
Jan J
JJ
Cornelissen
Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands.
Saskia
S
Middeldorp
Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands.
Bart J
BJ
Biemond
Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands.
Jan
J
Stam
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D001215:Asparaginase / Q000008:administration & dosage / Q000009:adverse effects*; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000209:etiology*; D017322:Clinical Trials, Phase II as Topic; D004334:Drug Administration Schedule; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D009426:Netherlands; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000188:drug therapy*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000209:etiology; D013129:Spinal Puncture / Q000009:adverse effects*; D013997:Time Factors; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000209:etiology*; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology*; D055815:Young Adult
D001215:Asparaginase; D008727:Methotrexate
Cerebral venous thrombosis; L-asparaginase; acute lymphoblastic leukemia; chemotherapy; risk factor; venous thrombosis