Prevalence of Lasparaginase Associated Thrombotic Events and Associated Factors in Adult Patients with Acute Lymphoblastic Leukemia in Tikur Anbessa Specialized Hospital.
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Date
2024-02
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Addis Ababa University
Abstract
Background –L-asparaginase is an important component of acute lymhoblastic leukemia
treatment. However, it is associated with increased risk of thrombosis which in turn affects
leukemia related outcomes and poses increased risk of mortality and morbidity.
Objective- To assess the prevalence of thrombotic events associated with L-asparaginase
treatment and its determinant factors in adult acute lymphoblastic leukemia patients treated in
Tikur Anbessa specialized hospital from November 2020- November 2023
Methodology: The study was conducted at Tikur Anbessa specialized hospital. A total of 152
patients who have been treated or are on treatment for acute lymphoblastic leukemia with L-
Asparginase containing regimens at Tikur Anbessa Specialized Hospital from November 2020 to
November 2023 were included in the study. Data was collected from the patient’s medical
records (both electronic and paper). Data was entered and analyzed with SPSS version 26, and a
chi-square test was used to assess the association of independent variables with the dependent
variable. Bi-variate and multivariate logistic regression were used to determine a significant
correlation between independent and dependent variables.
Results: A total of 152 patients were included in the study. The median age was 22.5 years (IQR
18, 30.8), and 59.9% of them were male. The pediatric inspired ALL CL10403 regimen was used
for treatment in 84.2% of cases, while CALGB 8811 protocol was used in the rest. The
prevalence of thrombotic events in acute lymphoblastic leukemia patients treated with an L-
asparaginase containing regimen was 11%. All of the events were venous, and cerebral venous
thrombosis was the commonest site of thrombosis, accounting for 41.2% of events, followed by
lower extremity deep vein thrombosis. The majority of events were symptomatic, and 44.4%
occurred during remission induction.
Longer time to achieve complete remission (>4 weeks), adjusted odds ratio AOR 4.8 (95% CI =
1.10, 20.72), and age ≥40 years AOR 10.4(95% CI = 1.47, 75.0) were significantly associated
with an increased risk of thrombotic events. Mortality was higher in patients with thrombotic
events (47%) when compared to patients who did not develop thrombosis (41.4%) but was not
statistically significant (P- value = 0.618). Mortality directly attributed to thrombotic events was
23.5% among patients who developed thrombosis.
Conclusion- This study showed that the risk of L-asparginase associated thrombosis in resource
limited settings like ours is comparable with previous reports from other parts of the world.
Longer time to achieve remission and age above 40 was associated with increased risk of
thrombosis.
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Keywords
Acute Lymphoblastic Leukemia (ALL), L-Asparaginase, Thrombosis