PB1428 - Incidence and predictors of venous thromboembolism in patients with acute lymphoblastic leukemia

Tuesday, June 25, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Co-Author(s)

DA

Daniela R. Anderson

Clinical Assistant Professor
Department of Family Medicine, University of Chicago, Chicago, IL, USA
Chicago, Illinois, United States
Radhika Gangaraju, MD, MSPH

Assistant Professor
Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
Birmingham, Alabama, United States
WS

Wafik George Sedhom

Hematology/Oncology Fellow
Department of Hematology and Oncology, Northwestern Memorial Hospital, Chicago, IL, USA
Chicago, Illinois, United States
EH

Eva N. Hamulyák

Assistant Professor
Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; and Department of Internal Medicine, OLVG, Amsterdam, The Netherlands
Amsterdam, Noord-Holland, Netherlands
Tzu-Fei Wang, MD, MPH

Associate Professor
Department of Medicine, University of Ottawa at The Ottawa Hospital, Ottawa, Canada
Ottawa, Ontario, Canada
KO

Kristen O'Dwyer

Associate Professor
Wilmot Cancer Institute of University of Rochester, Rochester, NY, USA
Rochester, New York, United States
BC

Brian J. Carney

Assistant Professor
Division of Hematology and Hematologic Malignancies, Beth Israel Deaconess Medical Center, Boston, MA, USA
Boston, Massachusetts, United States
ML

Michaela Liedtke

Associate Professor
Division of Hematology, Department of Medicine, Stanford Healthcare, Stanford, CA, USA
Palo Alto, California, United States
TB

Talha Badar

Assistant Professor
Division of Hematology, Mayo Clinic, Jacksonville, FL, USA
Jacksonville, Florida, United States
SS

Shai Shimony

Advanced Clinical Fellow
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
Boston, Massachusetts, United States
RR

Renana Robinson

Hematology Fellow
Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
Petah Tikva, Tel Aviv, Israel
Kristen M. Sanfilippo, MD, MPHS

Associate Professor of Medicine
Washington Univesrity School of Medicine in St. Louis, United States
AD

Andriy Derkach

Biostatistician
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
New York, New York, United States
SD

Shira Dinner

Associate Professor
Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
Chicago, Illinois, United States
BB

Bart J. Biemond

Internist-hematologist, Professor
Department of Hematology, Amsterdam University Medical Center, Amsterdam, The Netherlands
Amsterdam, Noord-Holland, Netherlands
CM

Chandrasekar Muthiah

Internal Medicine Resident
Division of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
Milwaukee, Wisconsin, United States
KS

Kimberly Seymour

Internal Medicine/Pediatrics Resident
University of Rochester Medical Center, Rochester, NY, USA
Rochester, New York, United States
Jeffrey I. Zwicker, MD

Chief of Hematology Service
Hematology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
New York, New York, United States
WS

Wendy Stock

Professor
Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
Chicago, Illinois, United States

Presenting Author(s)

Avi Leader, MD

Attending Physician
Memorial Sloan Kettering Cancer Center

Background: Patients with acute lymphoblastic leukemia (ALL) have a high risk of venous thromboembolism (VTE), especially after L-asparaginase (ASP) therapy.

Aims: To calculate incidence and risk factors for VTE in ALL with/without ASP-treatment.

Methods: We conducted a multi-center (n=13), international, retrospective cohort study of consecutive adult (≥18yrs) patients with newly-diagnosed ALL receiving induction chemotherapy. Patients on therapeutic anticoagulation at index were excluded. Patients were indexed at ALL diagnosis and followed for 100 days or until VTE, loss-to-follow-up, therapeutic anticoagulation or death. Primary outcome was VTE at any site (centrally adjudicated). Cumulative incidence of VTE was calculated with death as a competing risk, stratified for ASP-containing regimens. Stepwise Cox's proportional hazards regression was performed to identify VTE risk factors from a large set of clinical and laboratory measurements while adjusting for study center and use of thromboprophylaxis at index.

Results: The cohort included 744 patients with newly-diagnosed ALL; 429 in no-ASP cohort and 315 in ASP cohort (Table 1). The 90-day cumulative incidence of VTE was 13% [95% CI 9.6-16%] in the no-ASP cohort and 22% [17-27%] in the ASP-cohort. Most VTE occurred within 30 days in the ASP cohort (Figure 1A). There was no difference in VTE incidence with/without prophylactic/intermediate-dose low-molecular-weight-heparin prophylaxis in the ASP cohort (Figure 1B). On multivariable analysis of the ASP cohort, each 1gr/dl increase in hemoglobin was associated with 11% increase in VTE risk (HR 1.11 [1.00-1.23]), while antiplatelet therapy was protective (p=0.061). In the no-ASP cohort, T-ALL and mixed phenotype acute leukemia (p=0.010) and increasing platelet quartiles (e.g., HR 6.79 [2.09-22.1] when platelets≥114K/microliter; reference: < 24K/microliter) were VTE risk factors.

Conclusion(s): VTE risk during the first 100 days of ASP treatment in ALL remains high (22%), despite low-molecular-weight-heparin prophylaxis. VTE risk factors differed between patients with and without ASP-treatment, although platelets appear to play an important role in ALL-related thrombosis.