AUBMC, Beirut, Lebanon
Hassan Abdulmaoula Sibai, Jack Toshimine Seki, Tian Wang, Lalit Saini, Andrew Stessman, Joseph Samuel, Naoko Sakurai, Andre C. Schuh, Karen W. L. Yee, Mark D Minden, Aaron David Schimmer, Vikas Gupta, Mohamed Shanavas, Joseph M. Brandwein
Background: Venous thromboembolism (VTE) is a known complication in adults receiving asparaginase (ASNase) for acute lymphoblastic leukemia (ALL). We previously reported a 27.3% VTE rate in patients (pts) receiving a modified Dana Farber Cancer Institute (DFCI).We report updated results using two different dosing of enoxaparin as primary VTE prophylaxis. Methods: 62 pts ALL in complete remission, who were treated with a weekly ASNase-based DFCI intensification phase for at least 7 cycles (21 weeks) and received prophylaxis with enoxaparin targeted to 1 mg/kg subcutaneously (SC) daily (escalated dose group), were evaluated . Results were compared to a similar group of 41 patients who had received enoxaparin 40 mg for patients weighing less than 80 kg, and 60 mg for those 80 kg and above (low-dose group), and to a similar group of 99 pts previously treated with the same DFCI protocol without anticoagulation prophylaxis. Results: The actual mean dose of enoxaparin in the low-dose prophylaxis group was 0.62 mg/kg, as compared to 0.88 mg/kg in the escalated dose group. There were no major bleeding complications observed in the prophylaxis groups. The minor bleeding rate in the entire prophylaxis cohort was 4.8% (5/103), and was similar between the low-dose and escalated dosing groups. The VTE entire cohort that received prophylaxis was 20% (21/103). The VTE rates for all groups as shown in the table. Conclusions: Overall use of prophylactic enoxaparin during intensification in adults with ALL receiving ASNase was safe; escalating the enoxaparin dose to 1 mg/kg, did not increase the number of bleeding events. There was a trend toward a lower rate of VTE using dose-escalated enoxaparin, particularly in patients weighing < 80 kg.
Enoxaparin escalated dose(n = 62) | Enoxaparin low-dose (n = 41) | No Prophylaxis (n = 99) | All prophylaxis (n = 103) | P-value* | |
---|---|---|---|---|---|
Rate of VTE | 10/62 (16.1%) | 11/41 (26.8%) | 27/99(27.3%) | 21/103(20%) | 0.25 |
Weight < 80 kg | 7/49 (14.3%) | 4/26 (15.3%) | 18/67(26.9% ) | 11/72(15%) | 0.07 |
Weight ≥ 80 kg | 3/13 (23.1%) | 7/15 (46.7%) | 9/32 (28.1% ) | 10/28(35%) | 0.53 |
P value by weight | 0.44 | 0.03 | 0.90 | 0.02 | |
Minor bleeding events | 2(3%) | 3 (6%) | 5 (4.8%) | NS |
* comparing No vs ALL prophylaxis
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Abstract Disclosures
2023 ASCO Annual Meeting
First Author: Hannah Dysinger McLaughlin
2022 ASCO Annual Meeting
First Author: Ben Mautner
2015 ASCO Annual Meeting
First Author: Hassan Abdulmaoula Sibai
2023 ASCO Quality Care Symposium
First Author: Andrea Dickens