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dc.contributor.authorTuckuviene, R*
dc.contributor.authorRanta, S*
dc.contributor.authorAlbertsen, B K*
dc.contributor.authorAndersson, N G*
dc.contributor.authorBendtsen, M D*
dc.contributor.authorFrisk, T*
dc.contributor.authorGunnes, M W*
dc.contributor.authorHelgestad, J*
dc.contributor.authorHeyman, M M*
dc.contributor.authorJonsson, O G*
dc.contributor.authorMäkipernaa, A*
dc.contributor.authorPruunsild, K*
dc.contributor.authorTedgård, U*
dc.contributor.authorTrakymiene, S S*
dc.contributor.authorRuud, E*
dc.date.accessioned2016-05-03T14:24:14Zen
dc.date.available2016-05-03T14:24:14Zen
dc.date.issued2016-03en
dc.date.submitted2016en
dc.identifier.citationThromb. Haemost. 2016, 14 (3):485-94 J.en
dc.identifier.issn1538-7836en
dc.identifier.pmid26707629en
dc.identifier.doi10.1111/jth.13236en
dc.identifier.urihttp://hdl.handle.net/2336/607770en
dc.descriptionTo access publisher's full text version of this article click on the hyperlink at the bottom of the pageen
dc.description.abstractEssentials Children with acute lymphoblastic leukemia (ALL) are at risk of thromboembolism (TE). This is a prospective evaluation of the incidence, risk factors and outcomes of TE in 1038 children with ALL. TE occurred in 6.1% of children, with the highest incidence (20.5%) among those aged 15-17 years. A TE-associated case fatality of 6.4% indicates that TE is a severe complication of ALL treatment.
dc.description.abstractBackground Thromboembolism (TE) is a major toxicity in children with acute lymphoblastic leukemia (ALL) and may have a negative impact on ALL treatment. Objectives To examine the cumulative incidence, outcomes and risk factors associated with TE in children with leukemia. Patients/Methods We prospectively evaluated TE in 1038 Nordic children and adolescents (≥ 1 and < 18 years) diagnosed with ALL during 2008-2013 and treated according to the NOPHO (Nordic Society of Pediatric Hematology and Oncology)-ALL 2008 protocol. The cohort was followed until December 2014. Cox proportional regression was used to compute hazard ratios (HRs). Results TE events (n = 63) occurred most frequently in conjunction with asparaginase (ASP) administration (52/63). The cumulative incidence of TE was 6.1% (95% confidence interval [CI], 4.8-7.7). Being aged 15-17 years was associated with an increased risk of TE (adjusted HR of 4.0; 95% CI, 2.1-7.7). We found a TE-associated 30-day case fatality of 6.4% (95% CI, 1.8-15.5) and TE-related truncation of ASP therapy in 36.2% (21/58). Major hemorrhage occurred in 3.5% (2/58) of anticoagulated patients. Minor hemorrhage was reported in two out of 58 patients. No major bleeds occurred in children who received low-molecular-weight heparin. Conclusions Methods to identify children and adolescents who will benefit from thromboprophylaxis during ALL treatment are called for. The truncation of ASP should be avoided. The long-term survival outcomes for ALL patients with TE require close monitoring in the future.
dc.language.isoenen
dc.publisherWiley-Blackwellen
dc.relation.urlhttp://dx.doi.org/ 10.1111/jth.13236en
dc.rightsArchived with thanks to Journal of thrombosis and haemostasis : JTHen
dc.subjectPED12
dc.subject.meshPrecursor Cell Lymphoblastic Leukemia-Lymphomaen
dc.subject.meshAsparaginaseen
dc.subject.meshThromboembolismen
dc.subject.meshChild, Preschoolen
dc.subject.meshChilden
dc.titleProspective study of thromboembolism in 1038 children with acute lymphoblastic leukemia: a Nordic Society of Pediatric Hematology and Oncology (NOPHO) study.en
dc.typeArticleen
dc.contributor.department[ 1 ] Aalborg Univ Hosp, Dept Pediat, DK-9000 Aalborg, Denmark [ 2 ] Karolinska Univ Hosp, Childhood Canc Res Unit, Dept Womens & Childrens Hlth, Stockholm, Sweden [ 3 ] Karolinska Inst, Stockholm, Sweden [ 4 ] Aarhus Univ Hosp, Dept Pediat, DK-8000 Aarhus, Denmark [ 5 ] Lund Univ, Malmo Univ Hosp, Dept Pediat, Malmo, Sweden [ 6 ] Lund Univ, Malmo Univ Hosp, Dept Coagulat Disorders, Malmo, Sweden [ 7 ] Aalborg Univ, Dept Clin Med, Aalborg, Denmark [ 8 ] Haukeland Hosp, Dept Pediat, N-5021 Bergen, Norway [ 9 ] Landspitali Univ Hosp, Childrens Hosp, Reykjavik, Iceland   Organization-Enhanced Name(s)      Landspitali National University Hospital [ 10 ] Univ Helsinki, Childrens Hosp, Helsinki, Finland [ 11 ] Univ Helsinki, Cent Hosp, Ctr Canc, Dept Hematol, Helsinki, Finland [ 12 ] Tallinn Childrens Hosp, Dept Oncohematol, Tallinn, Estonia [ 13 ] Vilnius Univ Hosp Santariskiu Klin, Childrens Hosp, Ctr Pediat Oncol & Hematol, Vilnius, Lithuania [ 14 ] Oslo Univ Hosp, Rikshosp, Dept Pediat Med, Oslo, Norwayen
dc.identifier.journalJournal of thrombosis and haemostasis : JTHen
dc.rights.accessClosed - Lokaðen
html.description.abstractEssentials Children with acute lymphoblastic leukemia (ALL) are at risk of thromboembolism (TE). This is a prospective evaluation of the incidence, risk factors and outcomes of TE in 1038 children with ALL. TE occurred in 6.1% of children, with the highest incidence (20.5%) among those aged 15-17 years. A TE-associated case fatality of 6.4% indicates that TE is a severe complication of ALL treatment.
html.description.abstractBackground Thromboembolism (TE) is a major toxicity in children with acute lymphoblastic leukemia (ALL) and may have a negative impact on ALL treatment. Objectives To examine the cumulative incidence, outcomes and risk factors associated with TE in children with leukemia. Patients/Methods We prospectively evaluated TE in 1038 Nordic children and adolescents (≥ 1 and < 18 years) diagnosed with ALL during 2008-2013 and treated according to the NOPHO (Nordic Society of Pediatric Hematology and Oncology)-ALL 2008 protocol. The cohort was followed until December 2014. Cox proportional regression was used to compute hazard ratios (HRs). Results TE events (n = 63) occurred most frequently in conjunction with asparaginase (ASP) administration (52/63). The cumulative incidence of TE was 6.1% (95% confidence interval [CI], 4.8-7.7). Being aged 15-17 years was associated with an increased risk of TE (adjusted HR of 4.0; 95% CI, 2.1-7.7). We found a TE-associated 30-day case fatality of 6.4% (95% CI, 1.8-15.5) and TE-related truncation of ASP therapy in 36.2% (21/58). Major hemorrhage occurred in 3.5% (2/58) of anticoagulated patients. Minor hemorrhage was reported in two out of 58 patients. No major bleeds occurred in children who received low-molecular-weight heparin. Conclusions Methods to identify children and adolescents who will benefit from thromboprophylaxis during ALL treatment are called for. The truncation of ASP should be avoided. The long-term survival outcomes for ALL patients with TE require close monitoring in the future.


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