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 acutelymhoblastic 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 determinantfactorsinadult acute lymphoblastic leukemia patients treated inTikur Anbessa specialized hospital from November 2020- November 2023
Methodology: The study was conducted at Tikur Anbessa specializedhospital. A total of 152patients 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 toNovember 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 achi-square test was used to assess the association of independent variables with the dependentvariable. Bi-variate and multivariate logistic regression were used to determine a significantcorrelation between independent and dependent variables.
Results: A total of 152 patients were included in the study. The median age was 22.5 years (IQR18, 30.8), and 59.9% of them were male. The pediatric inspired ALL CL10403 regimen was usedfor treatment in 84.2% of cases, while CALGB 8811 protocol was used in the rest. Theprevalence 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 venousthrombosis was the commonest site of thrombosis, accounting for 41.2% of events, followed bylower 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 associatedwith an increased risk of thrombotic events. Mortality was higher in patients with thromboticevents (47%) when compared to patients who did not develop thrombosis (41.4%) but was notstatistically significant (P- value = 0.618). Mortality directly attributed to thrombotic events was23.5% among patients who developed thrombosis.
Conclusion- This study showed that the risk of L-asparginase associated thrombosis in resourcelimited 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 ofthrombosis.
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Acute Lymphoblastic Leukemia (ALL)L-AsparaginaseThrombosis, ,