Bleeding and thrombosis in children with acute lymphoblastic leukaemia, treated according to the ALL-BFM-90 protocol

A multi-center retrospective survey was conducted to evaluate the incidence and types of hemostatic complications occurring in children with acute lym phoblastic leukemia (ALL) during treatment according to the ALL-BFM-90 trea tment protocol. All of the BFM-treatment centers (n=77) were approached and a 95% response rate with information on 1100 patients was obtained. Thromb otic or bleeding episodes occurred in 31 patients (2.8%), 19 of whom had th rombosis and 12 bleeding complications, involving the central nervous syste m (42%), the subclavian vein (29%), the gastro-intestinal tract, skin, lowe r extremities or pelvis (29%). Recovery was noted in 28 of 31 patients, whi le 3 died as a result of hemostatic complications. Bleeding or thrombosis o ccurred in patients receiving prophylactic substitution with plasma or plas ma-derived concentrates (n=16) as well as in those without substitution (n= 13). The majority of hemostatic complications (90%) occurred during the ind uction therapy of the treatment protocol, in particular during the period w hich included simultaneous administration of glucocorticoids and E.coli L-a sparaginase The concurrent administration of E.coli L-asparaginase and gluc ocorticoids may be an additional risk factor for thromboembolic events duri ng therapy according to the ALL-BFM-90 protocol.