Solving coagulation conundrums: comparing prophylaxis strategies in adult patients receiving PEG-asparaginase

Abstract

PEG-asparaginase is a key component in treatment regimens for acute lymphoblastic leukemia (ALL). Major side effects include thrombosis and bleeding; however, there is currently no consensus on methods to prevent these complications. In this multi-center retrospective cohort study of 101 adults, we compared two prophylaxis strategies: cryoprecipitate and fresh frozen plasma (Cryo/FFP) versus cryoprecipitate and antithrombin (ATIII). The overall incidence of venous thromboembolism (VTE) was not significantly different between the two groups (19.7% for Cryo/FFP and 8.6% in Cryo/ATIII, p = 0.17), and neither was grade ≥3 bleeding (3% for Cryo/FFP and 11.4% for Cryo/ATIII, p = 0.18). Given the significant cost associated with ATIII without a clear benefit, a careful benefit and risk analysis should be considered before utilizing ATIII as a prophylaxis strategy to prevent thrombosis or bleeding following asparaginase administration.

Keywords:

• Acute lymphoblastic leukemia
• PEG-asparaginase
• thromboembolism
• cryoprecipitate
• antithrombin
• fresh frozen plasma

Disclosure statement

In accordance with Taylor & Francis policy and our ethical obligation as researchers, we are reporting that authors Anthony J. Perissinotti and Bernard L. Marini are consultants to Servier Pharmaceuticals, a company that may be affected by the research reported in the enclosed paper. We have disclosed those interests fully to Taylor & Francis.