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Mootoosamy C, Kondyli M, Serfaty SA, Tremblay DÉ, Gagné V, Ribère M, Laverdière C, Leclerc JM, Sinnett D, Tran TH, Krajinovic M. IL16 and factor V gene variations are associated with asparaginase-related thrombosis in childhood acute lymphoblastic leukemia patients. Pharmacogenomics 2023; 24:199-206. [PMID: 36946317 DOI: 10.2217/pgs-2022-0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Aim: We previously conducted exome-wide association study in acute lymphoblastic leukemia patients and identified association of five SNPs with asparaginase-related thrombosis. Here we aimed to replicate these findings in an independent patient cohort and through analyses in vitro. Patients & methods: SNPs located in IL16, MYBBP1A, PKD2L1, RIN3 and MPEG1 genes were analyzed in patients receiving Dana-Farber Cancer Institute acute lymphoblastic leukemia treatment protocols 05-001 and 11-001. Thrombophilia-related variations were also analysed. Results: IL16 rs11556218 conferred higher risk of thrombosis and higher in vitro sensitivity to asparaginase. The association was modulated by the treatment protocol, risk group and immunophenotype. A crosstalk between factor V Leiden, non-O blood groups and higher risk of thrombosis was also seen. Conclusion: IL16 and factor V Leiden variations are implicated in asparaginase-related thrombosis.
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Affiliation(s)
- Covida Mootoosamy
- Charles-Bruneau Cancer Center, CHU Sainte-Justine Research Center, Montreal, QC, H3T 1C5, Canada
- Department of Pharmacology & Physiology, Faculty of Medicine, University of Montreal, Montreal, QC, H3T 1J4, Canada
| | - Maria Kondyli
- Charles-Bruneau Cancer Center, CHU Sainte-Justine Research Center, Montreal, QC, H3T 1C5, Canada
| | - Sophie Annaelle Serfaty
- Charles-Bruneau Cancer Center, CHU Sainte-Justine Research Center, Montreal, QC, H3T 1C5, Canada
- Department of Pharmacology & Physiology, Faculty of Medicine, University of Montreal, Montreal, QC, H3T 1J4, Canada
| | - David-Étienne Tremblay
- Charles-Bruneau Cancer Center, CHU Sainte-Justine Research Center, Montreal, QC, H3T 1C5, Canada
| | - Vincent Gagné
- Charles-Bruneau Cancer Center, CHU Sainte-Justine Research Center, Montreal, QC, H3T 1C5, Canada
| | - Maïté Ribère
- Department of Biological Sciences, Faculty of Art & Science, University of Montreal, Montreal, QC, H3T 1J4, Canada
| | - Caroline Laverdière
- Charles-Bruneau Cancer Center, CHU Sainte-Justine Research Center, Montreal, QC, H3T 1C5, Canada
- Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, QC, H3T 1J4, Canada
| | - Jean-Marie Leclerc
- Charles-Bruneau Cancer Center, CHU Sainte-Justine Research Center, Montreal, QC, H3T 1C5, Canada
- Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, QC, H3T 1J4, Canada
| | - Daniel Sinnett
- Charles-Bruneau Cancer Center, CHU Sainte-Justine Research Center, Montreal, QC, H3T 1C5, Canada
- Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, QC, H3T 1J4, Canada
| | - Thai Hoa Tran
- Charles-Bruneau Cancer Center, CHU Sainte-Justine Research Center, Montreal, QC, H3T 1C5, Canada
- Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, QC, H3T 1J4, Canada
| | - Maja Krajinovic
- Charles-Bruneau Cancer Center, CHU Sainte-Justine Research Center, Montreal, QC, H3T 1C5, Canada
- Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, QC, H3T 1J4, Canada
- Department of Pharmacology & Physiology, Faculty of Medicine, University of Montreal, Montreal, QC, H3T 1J4, Canada
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Urabe F, Kimura S, Iwatani K, Yasue K, Koike Y, Tashiro K, Tsuzuki S, Sasaki H, Kimura T, Egawa S. The Impact of ABO Blood Type on Developing Venous Thromboembolism in Cancer Patients: Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10163692. [PMID: 34441987 PMCID: PMC8397199 DOI: 10.3390/jcm10163692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 01/11/2023] Open
Abstract
The impact of ABO blood type in the development of venous thromboembolism in cancer patients remains controversial. To develop a sense of the current opinion in this area, we conducted a systematic review and meta-analysis. In March 2021, we performed a systematic search of PubMed, the Cochrane library, and Scopus for studies that compared cancer patients who had a blood type of either O or non-O (A, B, and AB). Our objective was to use multivariate logistic regression analysis to determine how ABO blood type was associated with the development of venous thromboembolism. Our selection criteria were met by a total of nine studies in 25,884 patients for the systematic review and five studies in 22,777 patients for the meta-analysis. In cancer patients, we found that non-O blood type was associated with a nearly two-fold increase in risk of venous thromboembolism (pooled OR: 1.74, 95% CI: 1.44–2.10). Additionally, among the eligible patients, 21,889 patients were post-operative urological cancer patients. In these patients, the analysis also showed an association between non-O blood type and increasing risk of venous thromboembolism after pelvic surgery for malignancy (pooled OR: 1.73, 95% CI: 1.36–2.20). Our meta-analysis suggested that non-O blood type is a risk factor for venous thromboembolism among patients with cancer. As blood type is routinely determined preoperatively by objective and standardized methods, we anticipate that our results will be useful for managing venous thromboembolism in cancer patients, especially after pelvic surgery for urological cancers.
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Lam Shin Cheung J, Lam Shin Cheung V, Athale U. Impact of ABO Blood Group on the Development of Venous Thromboembolism in Children With Cancer: A Systematic Review and Meta-Analysis. J Pediatr Hematol Oncol 2021; 43:216-223. [PMID: 33165187 DOI: 10.1097/mph.0000000000001996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Few studies have evaluated the impact of ABO blood group on the risk of venous thromboembolism (VTE) in pediatric populations. We performed a systematic review to determine whether children (0 to 18 y old) with non-O blood group have an increased risk of developing VTE compared with those with O blood group. METHODS We searched Ovid Medline, Embase, PubMed, Cochrane, Web of Science, and CINAHL online databases from inception to December 2018 to find studies involving blood grouping and VTE. Data was collected regarding patients' underlying diseases, sex, age, ABO blood group, and VTE frequency. A meta-analysis using the random effect model was performed, and heterogeneity was assessed with the I2 value. RESULTS Among 1280 unique articles identified, 7 studies (3 conference abstracts, 4 peer-reviewed journal articles) involving 609 VTE cases were included in the systematic review. Six studies were eligible for a meta-analysis; all involved patients with cancer. Blood group O was protective against VTE (odds ratio, 0.56; 95% confidence interval, 0.43-0.79). Findings were similar across sensitivity analyses. CONCLUSIONS This systematic review has documented that O blood group is protective against new-onset VTE in children with cancer. Larger studies across different ethnic backgrounds and disease categories are needed to confirm these findings.
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Affiliation(s)
- Jeffrey Lam Shin Cheung
- Division of Hematology/Oncology, McMaster Children's Hospital, Hamilton Health Sciences, Hamilton
| | | | - Uma Athale
- Division of Hematology/Oncology, McMaster Children's Hospital, Hamilton Health Sciences, Hamilton
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Kashanian SM, Holtzman NG, Patzke CL, Cornu J, Duffy A, Koka M, Niyongere S, Duong VH, Baer MR, Apata J, Kamangar F, Emadi A. Venous thromboembolism incidence and risk factors in adults with acute lymphoblastic leukemia treated with and without pegylated E. coli asparaginase-containing regimens. Cancer Chemother Pharmacol 2021; 87:817-826. [PMID: 33677674 DOI: 10.1007/s00280-021-04252-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/25/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE Asparaginases, key agents in treatment of acute lymphoblastic leukemia (ALL), are associated with venous thromboembolism (VTE). While risks of short-acting asparaginase-related VTE is well-known, we studied VTE incidence and risk factors in adult ALL patients treated with and without long-acting pegylated asparaginase (PegA). METHODS Single-center, retrospective analysis of 89 ALL patients treated with (n = 61) or without (n = 28) PegA at Greenebaum Comprehensive Cancer Center. Reviewed patient and disease characteristics, treatment, and VTE incidence. RESULTS VTE during treatment occurred in 31 patients (35%), and was associated with PegA (p = 0.001) and Philadelphia chromosome negativity (p = 0.002). Among PegA recipients, VTE was associated with a significantly higher mean body mass index (BMI) of 31.3 kg/m2 (p = 0.037), and was more common with pre-T/T cell compared to pre-B/B cell ALL (68.2% vs. 33.3%, p = 0.009). Antithrombin-III (ATIII) levels were measured for 26 patients; 16 (61.5%) were < 50%. Of those, 8 (50%) experienced VTE, while 3 of 10 (30%) patients with ATIII levels ≥ 50% experienced VTE. VTE occurred in 7 of 13 (54%) of patients who received ATIII repletion. There was a trend toward a higher incidence of VTE in the PegA group among patients with non-O compared to O blood type (55.9% vs. 33.3%, p = 0.079) as well as those with a higher hemoglobin at diagnosis (9.3 vs 8.1 g/dL, p = 0.056). CONCLUSION This study confirms PegA as a risk factor for VTE in patients with ALL. Risk factors among those receiving PegA include higher BMI and pre-T/T cell ALL. ATIII repletion was not shown to be protective against VTE. There was a higher incidence of VTE in patients who received PegA with non-O compared to O blood type, but the precise correlation is uncertain.
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Affiliation(s)
- Sarah M Kashanian
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Noa G Holtzman
- Immune Deficiency Cellular Therapy Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 22 South Greene Street, Room N9E06, Baltimore, MD, 21201, USA
| | - Ciera L Patzke
- Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 22 South Greene Street, Room N9E06, Baltimore, MD, 21201, USA
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA
| | - Jonathan Cornu
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA
| | - Alison Duffy
- Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 22 South Greene Street, Room N9E06, Baltimore, MD, 21201, USA
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA
- University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Madhurima Koka
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sandrine Niyongere
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 22 South Greene Street, Room N9E06, Baltimore, MD, 21201, USA
| | - Vu H Duong
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 22 South Greene Street, Room N9E06, Baltimore, MD, 21201, USA
| | - Maria R Baer
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 22 South Greene Street, Room N9E06, Baltimore, MD, 21201, USA
| | - Jummai Apata
- Center for Urban Health Disparities Research and Innovation, Morgan State University, Baltimore, MD, USA
| | - Farin Kamangar
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD, USA
| | - Ashkan Emadi
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
- Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 22 South Greene Street, Room N9E06, Baltimore, MD, 21201, USA.
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, USA.
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Franca R, Zudeh G, Lucafò M, Rabusin M, Decorti G, Stocco G. Genome wide association studies for treatment-related adverse effects of pediatric acute lymphoblastic leukemia. WIREs Mech Dis 2020; 13:e1509. [PMID: 33016644 DOI: 10.1002/wsbm.1509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 08/01/2020] [Accepted: 09/04/2020] [Indexed: 12/14/2022]
Abstract
Acute lymphoblastic leukemia (ALL) is the most common pediatric hematological malignancy; notwithstanding the success of ALL therapy, severe adverse drugs effects represent a serious issue in pediatric oncology, because they could be both an additional life threatening condition for ALL patients per se and a reason to therapy delay or discontinuation with important fallouts on final outcome. Cancer treatment-related toxicities have generated a significant need of finding predictive pharmacogenomic markers for the a priori identification of at risk patients. In the era of precision medicine, high throughput genomic screening such as genome wide association studies (GWAS) might provide useful markers to tailor therapy intensity on patients' genetic profile. Furthermore, these findings could be useful in basic research for better understanding the mechanistic and regulatory pathways of the biological functions associated with ALL treatment toxicities. The purpose of this review is to give an overview of high throughput genomic screening of the last 10 years that had investigated the landscape of ALL treatment-associated toxicities. This article is categorized under: Cancer > Genetics/Genomics/Epigenetics.
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Affiliation(s)
- Raffaella Franca
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giulia Zudeh
- University of Trieste, PhD Course in Reproductive and Developmental Sciences, Trieste, Italy
| | - Marianna Lucafò
- Institute for Maternal and Child Health I.R.C.C.S Burlo Garofolo, Trieste, Italy
| | - Marco Rabusin
- Institute for Maternal and Child Health I.R.C.C.S Burlo Garofolo, Trieste, Italy
| | - Giuliana Decorti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.,Institute for Maternal and Child Health I.R.C.C.S Burlo Garofolo, Trieste, Italy
| | - Gabriele Stocco
- Department of Life Sciences, University of Trieste, Trieste, Italy
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Osada Y, Ito C, Nishiyama-Fujita Y, Ogura S, Sakurai A, Akimoto M, Aisa Y, Nakazato T. Prognostic Impact of ABO Blood Group on Survival in Patients With Malignant Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:122-129. [DOI: 10.1016/j.clml.2019.09.607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/09/2019] [Accepted: 09/21/2019] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Thrombosis is the formation of a blood clot, or thrombus, inside of a blood vessel. Pediatric patients with cancer are at a higher risk of developing a thrombus because of their underlying disease, as well as their treatment and supportive care. Thrombosis can lead to significant morbidity, such as pulmonary embolism, in pediatric patients with cancer. OBJECTIVES The purpose of this study is to identify risk factors for developing a thrombus among pediatric patients with cancer, along with treatment and prevention protocols. This study also examines the clinical nurse's role in preventing thrombosis and caring for pediatric patients who present with thrombosis. METHODS The thrombosis literature was reviewed to identify risk factors, treatment regimens, and strategies for prevention. FINDINGS Thrombosis in pediatric patients with cancer requires management of potential complications so that cancer treatment may continue.
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Groot HE, Villegas Sierra LE, Said MA, Lipsic E, Karper JC, van der Harst P. Genetically Determined ABO Blood Group and its Associations With Health and Disease. Arterioscler Thromb Vasc Biol 2020; 40:830-838. [PMID: 31969017 DOI: 10.1161/atvbaha.119.313658] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To determine the spectrum of phenotypes linked to the ABO blood group system, using genetic determinants of the ABO blood group system. Approach and Results: We assessed the risk of 41 health and disease outcomes, and 36 linear traits associated with the ABO blood group system in the UK Biobank cohort. A total of 406 755 unrelated individuals were included in this study. Blood groups A, B, and O were determined based on allele combinations of previously established single-nucleotide polymorphisms rs8176746, rs8176719 in the ABO gene. Group AB was excluded because of its relative small sample size. Overall, 187 387 (46%) were male with a mean (SD) age of 57±8.1 years and a median total exposure of 64 person-years (interquartile range, 57-70). Of 406 755 individuals, 182 621 (44.9%) participants had blood group O, 182 786 (44.9%) had blood group A, and 41 348 (10.2%) had blood group B. ABO blood groups were associated with 11 health and disease outcomes (P<2.19×10-4). ABO blood groups were primarily associated with cardiovascular outcomes. Compared with individuals with blood group O, blood groups A and B were associated with increased odds of up to 1.56 (95% CI, 1.43-1.69) for thromboembolic events and decreased odds for hypertension (0.94 [95% CI, 0.92-0.97]). CONCLUSIONS The ABO blood group system is associated with several parameters of healthy aging and disease development. Knowledge of ABO blood groups might be of interest for more personalized approaches towards health maintenance and the prevention of diseases.
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Affiliation(s)
- Hilde E Groot
- From the Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands (H.E.G., L.E.V.S., M.A.S., E.L., J.C.K., P.v.d.H.)
| | - Laura E Villegas Sierra
- From the Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands (H.E.G., L.E.V.S., M.A.S., E.L., J.C.K., P.v.d.H.).,University of Antioquia, School of Medicine, Medellín, Colombia (L.E.V.S.)
| | - M Abdullah Said
- From the Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands (H.E.G., L.E.V.S., M.A.S., E.L., J.C.K., P.v.d.H.)
| | - Erik Lipsic
- From the Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands (H.E.G., L.E.V.S., M.A.S., E.L., J.C.K., P.v.d.H.)
| | - Jacco C Karper
- From the Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands (H.E.G., L.E.V.S., M.A.S., E.L., J.C.K., P.v.d.H.)
| | - Pim van der Harst
- From the Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands (H.E.G., L.E.V.S., M.A.S., E.L., J.C.K., P.v.d.H.)
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9
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Pang H, Zong Z, Hao L, Cao Q. ABO blood group influences risk of venous thromboembolism and myocardial infarction. J Thromb Thrombolysis 2019; 50:430-438. [DOI: 10.1007/s11239-019-02012-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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10
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Candidate single nucleotide polymorphisms and thromboembolism in acute lymphoblastic leukemia – A NOPHO ALL2008 study. Thromb Res 2019; 184:92-98. [DOI: 10.1016/j.thromres.2019.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/28/2019] [Accepted: 11/04/2019] [Indexed: 01/30/2023]
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11
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Athale UH, Mizrahi T, Laverdière C, Nayiager T, Delva YL, Foster G, Thabane L, David M, Leclerc JM, Chan AKC. Impact of baseline clinical and laboratory features on the risk of thrombosis in children with acute lymphoblastic leukemia: A prospective evaluation. Pediatr Blood Cancer 2018; 65:e26938. [PMID: 29334169 DOI: 10.1002/pbc.26938] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/03/2017] [Accepted: 11/20/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Children with acute lymphoblastic leukemia (ALL) have increased risk of thromboembolism (TE). However, the predictors of ALL-associated TE are as yet uncertain. OBJECTIVE This exploratory, prospective cohort study evaluated the effects of clinical (age, gender, ALL risk group) and laboratory variables (hematological parameters, ABO blood group, inherited and acquired prothrombotic defects [PDs]) at diagnosis on the development of symptomatic TE (sTE) in children (aged 1 to ≤18) treated on the Dana-Farber Cancer Institute ALL 05-001 study. PROCEDURES Samples collected prior to the start of ALL therapy were evaluated for genetic and acquired PDs (proteins C and S, antithrombin, procoagulant factors VIII (FVIII:C), IX, XI and von Willebrand factor antigen levels, gene polymorphisms of factor V G1691A, prothrombin gene G20210A and methylene tetrahydrofolate reductase C677T, anticardiolipin antibodies, fasting lipoprotein(a), and homocysteine). RESULTS Of 131 enrolled patients (mean age [range] 6.4 [1-17] years) 70 were male patients and 20 patients (15%) developed sTE. Acquired or inherited PD had no impact on the risk of sTE. Multivariable analyses identified older age (odds ratio [OR] 1.13; 95% confidence interval [CI]: 1.01, 1.26) and non-O blood group (OR 3.64, 95% CI: 1.06, 12.51) as independent predictors for development of sTE. Patients with circulating blasts had higher odds of developing sTE (OR 6.66; 95% CI: 0.82, 53.85). CONCLUSION Older age, non-O blood group, and presence of circulating blasts, but not PDs, predicted the risk of sTE during ALL therapy. We recommend evaluation of these novel risk factors in the development of ALL-associated TE. If confirmed, these easily accessible variables at diagnosis can help develop a risk-prediction model for ALL-associated TE.
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Affiliation(s)
- Uma H Athale
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - T Mizrahi
- Division of Hematology/Oncology, Department of Pediatrics, CHU Ste-Justine, University of Montréal, Montréal, Canada
| | - C Laverdière
- Division of Hematology/Oncology, Department of Pediatrics, CHU Ste-Justine, University of Montréal, Montréal, Canada
| | - T Nayiager
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Y-L Delva
- Division of Hematology/Oncology, Department of Pediatrics, CHU Ste-Justine, University of Montréal, Montréal, Canada
| | - G Foster
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Biostatistics Unit, St Joseph's HealthCare, Hamilton, ON, Canada
| | - L Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Biostatistics Unit, St Joseph's HealthCare, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - M David
- Division of Hematology/Oncology, Department of Pediatrics, CHU Ste-Justine, University of Montréal, Montréal, Canada
| | - J-M Leclerc
- Division of Hematology/Oncology, Department of Pediatrics, CHU Ste-Justine, University of Montréal, Montréal, Canada
| | - A K C Chan
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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Gran OV, Brækkan SK, Hansen JB. Prothrombotic genotypes and risk of venous thromboembolism in cancer. Thromb Res 2018; 164 Suppl 1:S12-S18. [DOI: 10.1016/j.thromres.2017.12.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 12/29/2017] [Indexed: 12/21/2022]
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13
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Abaji R, Gagné V, Xu CJ, Spinella JF, Ceppi F, Laverdière C, Leclerc JM, Sallan SE, Neuberg D, Kutok JL, Silverman LB, Sinnett D, Krajinovic M. Whole-exome sequencing identified genetic risk factors for asparaginase-related complications in childhood ALL patients. Oncotarget 2018; 8:43752-43767. [PMID: 28574850 PMCID: PMC5546438 DOI: 10.18632/oncotarget.17959] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 04/27/2017] [Indexed: 01/19/2023] Open
Abstract
Allergy, pancreatitis and thrombosis are common side-effects of childhood acute lymphoblastic leukemia (ALL) treatment that are associated with the use of asparaginase (ASNase), a key component in most ALL treatment protocols. Starting with predicted functional germline variants obtained through whole-exome sequencing (WES) data of the Quebec childhood ALL cohort we performed exome-wide association studies with ASNase-related toxicities. A subset of top-ranking variants was further confirmed by genotyping (N=302) followed by validation in an independent replication group (N=282); except for thrombosis which was not available for that dataset. SNPs in 12 genes were associated with ASNase complications in discovery cohort including 3 that were associated with allergy, 3 with pancreatitis and 6 with thrombosis. The risk was further increased through combined SNPs effect (p≤0.002), suggesting synergistic interactions between the SNPs identified in each of the studied toxicities. Interestingly, rs3809849 in the MYBBP1A gene was associated with allergy (p= 0.0006), pancreatitis (p=0.002), thrombosis (p=0.02), event-free survival (p=0.02) and overall survival (p=0.003). Furthermore, rs11556218 in IL16 and rs34708521 in SPEF2 were both associated with thrombosis (p=0.01 and p=0.03, respectively) and pancreatitis (p=0.02). The association of SNPs in MYBBP1A, SPEF2 and IL16 geneswith pancreatitis was replicated in the validation cohort (p ≤0.05) as well as in combined cohort (p=0.0003, p=0.008 and p=0.02, respectively). The synergistic effect of combining risk loci had the highest power to predict the development of pancreatitis in both cohorts and was further potentiated in the combined cohort (p=1×10-8). The present work demonstrates that using WES data is a successful “hypothesis-free” strategy for identifying significant genetic markers modulating the effect of the treatment in childhood ALL.
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Affiliation(s)
- Rachid Abaji
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada.,Department of Pharmacology, University of Montreal, Montreal, QC, Canada
| | - Vincent Gagné
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Chang Jiang Xu
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | | | - Francesco Ceppi
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Caroline Laverdière
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada.,Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | - Jean-Marie Leclerc
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada.,Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | - Stephen E Sallan
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Hematology/Oncology, Children's Hospital, Boston, MA, USA
| | - Donna Neuberg
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jeffery L Kutok
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Lewis B Silverman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Hematology/Oncology, Children's Hospital, Boston, MA, USA
| | - Daniel Sinnett
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada.,Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | - Maja Krajinovic
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada.,Department of Pediatrics, University of Montreal, Montreal, QC, Canada.,Department of Pharmacology, University of Montreal, Montreal, QC, Canada
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14
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Theron A, Biron-Andreani C, Haouy S, Saumet L, Saguintah M, Jeziorski E, Sirvent N. [Thromboembolic disease in pediatric oncology]. Arch Pediatr 2018; 25:139-144. [PMID: 29325825 DOI: 10.1016/j.arcped.2017.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 08/20/2017] [Accepted: 10/26/2017] [Indexed: 11/30/2022]
Abstract
The survival rate of children with cancer is now close to 80 %, as a result of continuous improvement in diagnostic and treatment procedures. Prevention and treatment of treatment-associated complications is now a major challenge. Thromboembolic venous disease, due to multifactorial pathogenesis, is a frequent complication (up to 40 % asymptomatic thrombosis in children with cancer), responsible for significant morbidity. Predominantly in children with acute lymphoblastic leukemia, lymphoma, or sarcoma, thromboembolic disease justifies primary prophylaxis in certain populations at risk, whether genetic or environmental. The curative treatment, well codified, is based on the administration of low-molecular-weight heparin. In the absence of robust pediatric prospective studies, this article proposes a concise decision tree summarizing the preventive and curative strategy.
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Affiliation(s)
- A Theron
- Département d'onco-hématologie pédiatrique, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France; Département d'hématologie biologie, centre régional de traitement de l'hémophilie, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France.
| | - C Biron-Andreani
- Département d'hématologie biologie, centre régional de traitement de l'hémophilie, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - S Haouy
- Département d'onco-hématologie pédiatrique, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - L Saumet
- Département d'onco-hématologie pédiatrique, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - M Saguintah
- Département de radiologie pédiatrique, CHRU de Montpellier, 371, avenue du Doyen-Gaston Giraud, 34090 Montpellier, France
| | - E Jeziorski
- Département de pédiatrie générale, CHU de Montpellier, 371, avenue du Doyen-Gaston Giraud, 34090 Montpellier, France
| | - N Sirvent
- Département d'onco-hématologie pédiatrique, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
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15
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Abstract
Paediatric venous thromboembolism (VTE) is a rare disorder but a rising incidence has been observed in recent years, due to improved VTE diagnosis and increased use of central venous catheters in the treatment of severe diseases. Risk assessment strategies are well established for adult patients, however, similar guidelines for paediatric patients are largely lacking. Several risk prediction tools have been reported in recent literature, which make use of established risk factors to assess VTE risk in paediatric subgroups, such as hospitalised children, cancer-diagnosed children and paediatric trauma patients. Although these models suffer several limitations regarding their study size and heterogeneous selection of predictor variables, they offer potential for improving the thromboprophylaxis management in these children. Here, we give an overview on recently reported risk prediction models for paediatric VTE.
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Affiliation(s)
- Frank Rühle
- Department of Genetic Epidemiology, Institute of Human Genetics, University of Münster, Münster, Germany
| | - Monika Stoll
- Department of Genetic Epidemiology, Institute of Human Genetics, University of Münster, Münster, Germany.,Department of Biochemistry, Genetic Epidemiology and Statistical Genetics, CARIM School for Cardiovascular Diseases, Maastricht Centre for Systems Biology (MaCSBio), Maastricht University, Maastricht, The Netherlands
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16
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Ghanem KM, Dhayni RM, Al-Aridi C, Tarek N, Tamim H, Chan AKC, Saab R, Abboud MR, El-Solh H, Muwakkit SA. Cerebral sinus venous thrombosis during childhood acute lymphoblastic leukemia therapy: Risk factors and management. Pediatr Blood Cancer 2017; 64. [PMID: 28660695 DOI: 10.1002/pbc.26694] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/16/2017] [Accepted: 05/30/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Cerebral sinus venous thrombosis (CSVT) is a rare but serious complication of childhood acute lymphoblastic leukemia (ALL) therapy. No available consensus exists regarding its risk factors and appropriate management due to the rarity of cases. PROCEDURES Out of 209 ALL patients aged 1-21 years treated at the Children's Cancer Center of Lebanon between May 2002 and May 2015, 13 developed CSVT during therapy. Patient characteristics, clinical management, and outcomes were studied. RESULTS The incidence of CSVT was 6.2% (95% confidence interval [CI]: 3.4-10.4). Using univariate analysis, increased risk of CSVT was observed with age >10 years (odds ratio [OR]: 3.56, 95% CI: 1.13-11.2), T-cell immunophenotype (OR: 4.14, 95% CI: 1.16-14.7), and intermediate/high risk disease (OR: 3.4, 95% CI: 1.03-11.7). The only statistically significant risk factor by multivariate analysis was the treatment as per the intermediate-/high-risk protocol (HR: 15.6, 95% CI: 1.43-171.3). Most cases (77%) occurred in the postinduction phases of treatment while receiving a combination of asparaginase and dexamethasone rather than prednisone. Treatment with low molecular weight heparin (LMWH) for a minimum of 3 months and until significant radiological improvement is observed resulted in 100% survival rate. All but one patient had complete neurological recovery. CONCLUSIONS CSVT is an important complication of childhood ALL therapy. Postinduction combined asparaginase and dexamethasone intensive treatment for intermediate-/high-risk patients was the most important risk factor. Treatment with LMWH for a minimum of 3 months, and until asparginase therapy is over, with major radiological improvement seems to be effective and feasible.
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Affiliation(s)
- Khaled M Ghanem
- Department of Pediatrics and Adolescent Medicine, Hematology Oncology Service, Children's Cancer Center of Lebanon, American University of Beirut, Beirut, Lebanon
| | - Raghida M Dhayni
- Department of Pediatrics and Adolescent Medicine, Hematology Oncology Service, Children's Cancer Center of Lebanon, American University of Beirut, Beirut, Lebanon
| | - Carol Al-Aridi
- Department of Pediatrics and Adolescent Medicine, Hematology Oncology Service, Children's Cancer Center of Lebanon, American University of Beirut, Beirut, Lebanon
| | - Nidale Tarek
- Department of Pediatrics and Adolescent Medicine, Hematology Oncology Service, Children's Cancer Center of Lebanon, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Anthony K C Chan
- Department of Pediatrics, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Raya Saab
- Department of Pediatrics and Adolescent Medicine, Hematology Oncology Service, Children's Cancer Center of Lebanon, American University of Beirut, Beirut, Lebanon
| | - Miguel R Abboud
- Department of Pediatrics and Adolescent Medicine, Hematology Oncology Service, Children's Cancer Center of Lebanon, American University of Beirut, Beirut, Lebanon
| | - Hassan El-Solh
- Department of Pediatrics and Adolescent Medicine, Hematology Oncology Service, Children's Cancer Center of Lebanon, American University of Beirut, Beirut, Lebanon
| | - Samar A Muwakkit
- Department of Pediatrics and Adolescent Medicine, Hematology Oncology Service, Children's Cancer Center of Lebanon, American University of Beirut, Beirut, Lebanon
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17
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Li YJ, Yi PY, Li JW, Liu XL, Tang T, Zhang PY, Jiang WQ. Prognostic role of ABO blood type in patients with extranodal natural killer/T cell lymphoma, nasal type: a triple-center study. CHINESE JOURNAL OF CANCER 2017; 36:62. [PMID: 28756771 PMCID: PMC5535286 DOI: 10.1186/s40880-017-0229-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 03/01/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND The prognostic significance of ABO blood type for lymphoma is largely unknown. We evaluated the prognostic role of ABO blood type in patients with extranodal natural killer (NK)/T-cell lymphoma (ENKTL). METHODS We retrospectively analyzed clinical data of 697 patients with newly diagnosed ENKTL from three cancer centers. The prognostic value of ABO blood type was evaluated using Kaplan-Meier curves and Cox proportional hazard models. The prognostic values of the International Prognostic Index (IPI) and the Korean Prognostic Index (KPI) were also evaluated. RESULTS Compared with patients with blood type O, those with blood type non-O tended to display elevated baseline serum C-reactive protein levels (P = 0.038), lower rate of complete remission (P = 0.005), shorter progression-free survival (PFS, P < 0.001), and shorter overall survival (OS, P = 0.001). Patients with blood type O/AB had longer PFS (P < 0.001) and OS (P = 0.001) compared with those with blood type A/B. Multivariate analysis demonstrated that age >60 years (P < 0.001), mass ≥5 cm (P = 0.001), stage III/IV (P < 0.001), elevated serum lactate dehydrogenase (LDH) levels (P = 0.001), and blood type non-O were independent adverse predictors of OS (P = 0.001). ABO blood type was found to be superior to both the IPI in discriminating patients with different outcomes in the IPI low-risk group and the KPI in distinguishing between the intermediate-to-low- and high-to-intermediate-risk groups. CONCLUSIONS ABO blood type was an independent predictor of clinical outcome for patients with ENKTL.
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Affiliation(s)
- Ya-Jun Li
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, 283 Tongzipo Road, Yuelu District, Changsha, 410013 Hunan P. R. China
- The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013 Hunan P. R. China
| | - Ping-Yong Yi
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, 283 Tongzipo Road, Yuelu District, Changsha, 410013 Hunan P. R. China
- The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013 Hunan P. R. China
| | - Ji-Wei Li
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, 283 Tongzipo Road, Yuelu District, Changsha, 410013 Hunan P. R. China
- The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013 Hunan P. R. China
| | - Xian-Ling Liu
- Cancer Center of the Second Xiangya Hospital, Central South University, Changsha, 410013 Hunan P. R. China
| | - Tian Tang
- The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013 Hunan P. R. China
- Radioactive Interventional Department, Hunan Cancer Hospital, Changsha, 410013 Hunan P. R. China
| | - Pei-Ying Zhang
- Integration Medicine Department, Hunan Chest Hospital, Changsha, Hunan 410013 P. R. China
| | - Wen-Qi Jiang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng RD East, Guangdong, 510060 Guangdong P. R. China
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18
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Yu M, Wang C, Chen T, Hu S, Yi K, Tan X. ABO blood groups and risk of deep venous thromboembolism in Chinese Han population from Chaoshan region in South China. Saudi Med J 2017; 38:396-399. [PMID: 28397946 PMCID: PMC5447192 DOI: 10.15537/smj.2017.4.16349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 12/05/2016] [Indexed: 02/05/2023] Open
Abstract
UNLABELLED Objectives: To demonstrate the prevalence of ABO blood groups with deep venous thromboembolism in Chinese Han population. METHODS A retrospective study was conducted between January 2010 and March 2015 in The First Affiliated Hospital of Shantou University Medical College in Chaoshan District of Guangdong Province in South China. Eighty nine patients with confirmed diagnosis of deep venous thromboembolism were included. Frequency of blood groups was determined. Results: Of 89 patients with deep venous thromboembolism, 28 patients had blood group A (31.5%), 28 patients had blood group B (31.5%), 13 patients had blood group AB (14.6%), and 20 patients had blood group O (22.5%). Compared with O blood type, the odds ratios of deep venous thromboembolism for A, B and AB were 2.23 (95% CI, 1.27-3.91), 2.34 (95% CI, 1.34-4.09) and 4.43 (95% CI, 2.24-8.76). Conclusion: There is a higher risk of venous thromboembolism in non-O blood groups than O group.
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Affiliation(s)
- Min Yu
- Department of Cardiology, The First Affiliated Hospital, Shantou University Medical College, Shantou, China. E-mail.
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19
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Spavor M, Halton J, Dietrich K, Israels S, Shereck E, Yong J, Yasui Y, Mitchell LG. Age at cancer diagnosis, non-O blood group and asparaginase therapy are independently associated with deep venous thrombosis in pediatric oncology patients: A risk model. Thromb Res 2016; 144:27-31. [PMID: 27270219 DOI: 10.1016/j.thromres.2016.05.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/26/2016] [Accepted: 05/18/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Pediatric oncology patients are at increased risk for deep venous thrombosis (DVT). Determining the sub-population of children at increased DVT risk is critical for optimum clinical management. Therefore, the aim of the current study was to identify clinical risk factors for DVT which are easily identifiable at cancer diagnosis. MATERIALS AND METHODS A Canadian multicenter case control study in survivors of childhood cancer. Survivors who had DVT (Cases) while being treated for pediatric cancer where matched by center with a minimum of two survivors who did not experience DVT (Controls). Clinical information including age at diagnosis, type of cancer and chemotherapy were collected. Genotyping of blood group was done by single nucleotide polymorphisms analysis. RESULTS 218 subjects were recruited at 4 Canadian pediatric centers. Multivariable analysis demonstrated 3 significant variables (reported as Odds Ratio (OR), (95% CI), p value): age at diagnosis p<0.001, non-O blood group OR 2.6 (1.3-5.2) p=0.005 and asparaginase treatment OR 2.4 (1.2-4.8) p=0.011. In order to optimise clinical utility, we reanalysed the study data with age at diagnosis categorised into four subgroups 0-≤2years, >2-≤7years, >7≤10years, >10years. A significant association with DVT were seen in children 0-≤2years (OR 3.1 (1.1-8.3) p=0.026) and >10years (OR 3.8, 1.7-8.5 p=0.001). Significant associations with DVT remained for non-O blood group, OR 2.2 (1.2-4.4) p=0.016 and asparaginase treatment, OR 2.1 (1.1-4.0) p=0.027. The value for the clinical risk model receiver operating characteristics curve was 0.67. CONCLUSIONS We have shown 3 independent risk factors for DVT in childhood cancer.
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Affiliation(s)
- Maria Spavor
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Sara Israels
- Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Evan Shereck
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Jian Yong
- University of Alberta, Edmonton, Alberta, Canada
| | - Yutaka Yasui
- University of Alberta, Edmonton, Alberta, Canada
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20
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Goyal G, Bhatt VR. L-asparaginase and venous thromboembolism in acute lymphocytic leukemia. Future Oncol 2015; 11:2459-70. [PMID: 26274336 DOI: 10.2217/fon.15.114] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The occurrence of venous thromboembolism (VTE) in acute lymphocytic leukemia patients receiving L-asparaginase therapy may cause significant morbidity, neurological sequela and possibly worse outcomes. The prophylactic use of antithrombin infusion (to keep antithrombin activity >60%) or low molecular weight heparin (LMWH) may reduce the risk of VTE. The decision to continue L-asparaginase therapy after the development of VTE should be based on anticipated benefits, severity of VTE and the ability to continue therapeutic anticoagulation. In patients receiving asparaginase rechallenge, the use of therapeutic LMWH, monitoring of anti-Xa level and antithrombin level are important. Novel oral anticoagulants are not dependent on antithrombin level, hence offer theoretical advantages over LMWH for the prevention and therapy of asparaginase-related VTE.
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Affiliation(s)
- Gaurav Goyal
- Department of Internal Medicine, Creighton University School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA
| | - Vijaya Raj Bhatt
- Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, 987680 Nebraska Medical Center, Omaha, NE 68198, USA
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