| Title | The impact of prophylactic fresh frozen plasma and cryoprecipitate on the incidence of CNS thrombosis and hemorrhage in children with acute lymphoblastic leukemia receiving asparaginase. | | Author(s) | Abbott LS, Deevska M, Fernandez CV, Dix D, Price VE, Wang H, Parker L, Yhap M, Fitzgerald C, Barnard DR, Berman JN | | Institution | Dalhousie University and IWK Health Centre, Canada; | | Source | Blood 2009 Oct 12. | | Abstract | Asparaginase (ASP) therapy is associated with depletion of antithrombin (AT) and fibrinogen (FG). Potential toxicities include CNS thrombosis (CNST) and hemorrhage. Historical practice at the IWK Health Centre (IWK) involves measuring AT and FG levels following ASP administration and transfusing fresh frozen plasma (FFP) or cryoprecipitate (CRY) to prevent thrombotic and hemorrhagic complications. To determine if this practice reduced these complications in children with acute lymphoblastic leukemia (ALL) receiving ASP, incidence, outcome and clinical characteristics of ASP-related CNST in ALL patients at IWK were compared to a similarly treated cohort from B.C. Children's Hospital (BCCH), where prophylaxis was not performed. Costs associated with preventative versus expectant management strategies were estimated. From 1990-2005, 240 patients were treated at IWK and 479 at BCCH. Seven BCCH patients developed venous CNST (1.5%), compared with none at IWK. CNST occurred exclusively during induction. Six patients received anti-coagulation and continued ASP. The remaining patient discontinued ASP. All remain in remission. NCI high risk (HR) ALL predicted CNST risk (p=0.02), while gender, age, race, and BMI did not. Neither FFP nor CRY protected against CNST, suggesting prophylaxis is unwarranted for unselected ALL patients. However, prophylactic replacement for HR patients in induction may be appropriate and cost-effective. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 19822902 |
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