Managing and Preventing Hypofibrinogenemia in Pediatric and AYA Leukemia Patients: Insights From MD Anderson Cancer Center.

Abstract

Background: Cryoprecipitate is often used to prevent and treat complications associated with low fibrinogen levels in pediatric leukemia patients. Cryoprecipitate, rich in fibrinogen, is administered to augment fibrinogen levels and mitigate the risk of bleeding in these patients. The use of cryoprecipitate is often strategic, involving both prophylactic measures and interventions in response to bleeding events. This approach plays a crucial role in the comprehensive care of pediatric leukemia patients, particularly during periods of heightened vulnerability to bleeding complications. However, data regarding the use of cryoprecipitate in children with leukemia are lacking.

Methods: We conducted a retrospective chart review of children, adolescents, and young adults with leukemia who received cryoprecipitate at the University of Texas MD Anderson Cancer Center from 2020 to 2022. We gathered baseline clinical and demographic data, cryoprecipitate usage details, and fibrinogen levels. Paired-samples t tests were used to compare fibrinogen levels before and after cryoprecipitate infusion.

Results: We identified 36 patients who received cryoprecipitate, 1 to 25 years of age, 67% of whom (24/36) were male. In this cohort, 27/36 (75%) were recently exposed to asparaginase, 2/36 (6%) had a history of venous thromboembolism, and 6/36 (17%) had a history of major bleeding. Cryoprecipitate was used to treat active bleeding (11/36, 31%), bleeding prevention (22/36, 61%), and preoperatively (3/36, 8%). Patients frequently required transfusions of other blood products. Common comorbidities in patients receiving cryoprecipitate included disseminated intravascular coagulation (10/36, 28%) and sepsis (10/36, 28%). The median baseline fibrinogen level across the entire study population was 85.5 mg/dL (IQR: 59.8 to 113). The median dose of cryoprecipitate infused was 6.6 mL/kg (IQR: 3.09 to 14.6), and the median postinfusion peak fibrinogen level was 185 mg/dL (IQR: 155 to 292) ( P <0.001). No major direct treatment-related adverse events were reported.

Conclusion: Cryoprecipitate is commonly administered to children with leukemia, effectively raising fibrinogen levels with minimal associated side effects. However, further research, ideally through randomized trials, is needed to assess its true clinical benefits in this population. Currently, there is a notable lack of pediatric-focused randomized transfusion medicine trials. Integrating these studies into ongoing oncologic trials could be a practical and valuable approach that warrants careful consideration and planning.