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

• Published in: Current oncology (Toronto) Vol. 23; no. 4; pp. e355 - 361
• Main Authors: Sibai, H, Seki, J T, Wang, T Q, Sakurai, N, Atenafu, E G, Yee, K W L, Schuh, A C, Gupta, V, Minden, M D, Schimmer, A D, Brandwein, J M
• Format: Journal Article
• Language: English
• Published: Canada Multimed Inc 01.08.2016
• Subjects: Original; Anticoagulants; leukemia; asparaginase; prophylaxis; venous thromboembolism
• ISSN: 1198-0052; 1718-7729; 1718-7729
• DOI: 10.3747/co.23.3077

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