Clinical outcomes following catheter-related venous thrombo-embolism among children with acute lymphoblastic leukemia

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research Pub Date : 2026-05-01 Epub Date: 2026-04-22 DOI:10.1016/j.thromres.2026.109691

Marie-Claude Pelland-Marcotte , Thai Hoa Tran , Chantal Éthier , Camille Beaulieu , Thien Vu Truong , Olivia Perrone , Nadia Tarhini , Juliann Duzan , Lynda M. Vrooman , Melissa Burns , Lewis B. Silverman , Riten Kumar

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Abstract

Venous thrombo-embolism (VTE) occurs in 10–15% of pediatric patients with acute lymphoblastic leukemia (ALL), yet the optimal duration of anticoagulation remains unclear. In this retrospective multi-center cohort study, we reported the clinical outcomes of pediatric patients treated for ALL with a history of central venous catheter (CVC)-related VTE and compared outcomes based on duration of anticoagulation.

Patients aged 1–21 years old with newly-diagnosed ALL (2010−2023), receiving asparaginase-containing chemotherapy, experiencing a radiologically-proven CVC-related VTE requiring medical intervention, were included. Cumulative incidence and 95% confidence interval (CI) were estimated for VTE progression/recurrence and clinically relevant bleeding. Cox proportional hazard models were performed to compare clinical outcomes based on anticoagulation duration, categorized as a) asparaginase-based (following a 6-week course of anticoagulation, until the end of asparaginase’ expected effects or earlier) or extended (later than asparaginase's expected effects), and b) before vs. after CVC removal.

We included 106 patients (median age: 10 years, 59% male). Overall, 22 patients sustained a VTE progression/recurrence (cumulative incidence: 22%, 95% CI: 14–30%). Most progression/recurrences occurred while patients were still on anticoagulation, at a median of 54 days after index VTE. Duration of anticoagulation was not associated with VTE progression/recurrence (extended vs. asparaginase-based: HR = 1.49, 95%CI: 0.60–3.69, p = 0.392; after vs. before CVC removal: HR = 1.36, 95% CI: 0.49–3.74, p = 0.552). Clinically relevant bleeding occurred in 11/106 patients (cumulative incidence: 12%, 95% CI: 6–19%) and was not associated with anticoagulation duration.

In summary, VTE progression/recurrence was common in pediatric patients with ALL. Further investigation into alternative approaches to reduce VTE progression/recurrence is warranted.

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急性淋巴细胞白血病患儿导管相关性静脉血栓栓塞后的临床结果。

静脉血栓栓塞（VTE）发生在10-15%的儿科急性淋巴细胞白血病（ALL）患者中，但抗凝治疗的最佳持续时间尚不清楚。在这项回顾性多中心队列研究中，我们报告了患有中心静脉导管（CVC）相关静脉血栓栓塞（VTE）病史的ALL患儿的临床结果，并根据抗凝时间对结果进行了比较。患者年龄1-21岁，新诊断ALL(2010-2023)，接受含天冬酰胺酶化疗，经历放射学证实的cvc相关静脉血栓栓塞需要医疗干预。估计静脉血栓栓塞进展/复发和临床相关出血的累积发生率和95%可信区间（CI）。采用Cox比例风险模型来比较基于抗凝时间的临床结果，分为a)基于天冬酰胺酶的（在6周的抗凝治疗后，直到天冬酰胺酶的预期效果结束或更早）或延长（晚于天冬酰胺酶的预期效果），b)去除CVC之前和之后。我们纳入106例患者（中位年龄：10岁，59%为男性）。总体而言，22名患者持续静脉血栓栓塞进展/复发（累积发病率：22%，95% CI: 14-30%）。大多数进展/复发发生在患者仍在抗凝治疗期间，在指数静脉血栓栓塞后的中位54天。抗凝时间与静脉血栓栓塞进展/复发无关（延长与基于天冬酰胺酶：HR = 1.49, 95%CI: 0.60-3.69, p = 0.392； CVC去除后与去除前：HR = 1.36, 95%CI: 0.49-3.74, p = 0.552）。11/106例患者发生临床相关出血（累积发生率：12%，95% CI: 6-19%），且与抗凝时间无关。总之，静脉血栓栓塞进展/复发在ALL患儿中很常见。进一步研究减少静脉血栓栓塞进展/复发的替代方法是必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Thrombosis research 医学-外周血管病

CiteScore

14.60

自引率

4.00%

发文量

364

审稿时长

31 days

期刊介绍： Thrombosis Research is an international journal dedicated to the swift dissemination of new information on thrombosis, hemostasis, and vascular biology, aimed at advancing both science and clinical care. The journal publishes peer-reviewed original research, reviews, editorials, opinions, and critiques, covering both basic and clinical studies. Priority is given to research that promises novel approaches in the diagnosis, therapy, prognosis, and prevention of thrombotic and hemorrhagic diseases.