Clinical Course of Cerebral Venous Thrombosis in Adult Acute Lymphoblastic Leukemia

Susanna M. Zuurbier, Mandy N. Lauw, Jonathan M. Coutinho, Charles B. L. M. Majoie, Bronno van der Holt, Jan J. Cornelissen, Saskia Middeldorp, Bart J. Biemond, Jan Stam

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Abstract

Venous thromboembolism (VTE) is a frequent complication in patients with acute lymphoblastic leukemia (ALL). A significant proportion of patients develop cerebral venous thrombosis (CVT). To investigate risk factors for and the clinical course of CVT in ALL patients, we describe all cases of CVT which occurred in a well-defined cohort of 240 adults, treated for newly diagnosed ALL in the HOVON (Dutch-Belgian Hemato-Oncology Cooperative Group)-37 study. We conducted a nested case-control study to explore the relevance of early symptoms and risk factors for CVT in ALL patients. Nine of 240 patients developed CVT (4%). CVT occurred during or shortly after L-asparaginase therapy (in 8 cases) and shortly after intrathecal methotrexate injections (in all cases) during cycle I of remission induction treatment. CVT was associated with prior headache and seizures. In 5 of 9 patients with CVT, headache before the diagnosis of CVT occurred within 3 days after lumbar puncture and initially had a postural character. CVT is relatively common in adult ALL patients. Our data suggest that CVT in adult ALL patients results from the additive effects of multiple risk factors, with a particular role for asparaginase and the effects of lumbar punctures for intrathecal therapy
Original languageEnglish
Pages (from-to)1679-1684
JournalJournal of Stroke and Cerebrovascular Diseases
Volume24
Issue number7
DOIs
Publication statusPublished - 2015

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