Obesity Is Not Associated With An Increased Risk Of Venous Thromboembolism In Aya Patients With Acute Lymphoblastic Leukemia

Context: Acute venous thromboembolisms (VTEs) are a serious complication during intensive chemotherapy. Risk factors associated with VTEs, specifically in the adolescent and young adult (AYA) population being treated per pediatric protocols for acute lymphoblastic leukemia (ALL), are poorly described in the literature. Objective: To determine whether baseline demographic data, specifically obesity and asparaginase dose, are risk factors for VTEs in AYA patients. Design, Setting, and Patients: Patients were studied retrospectively from 2009 to 2020. Tertiary referral center. A cohort of 66 adolescent and young adult patients, ages 15 to 26 years, with previously untreated ALL was identified and divided into groups based on the presence or absence (controls) of VTEs during ALL treatment. All patients were treated with Berlin-Frankfurt-Munster (BFM)-based pediatric chemotherapy protocols. Main Outcome Measures: We hypothesized that AYA patients being treated per BFM-based pediatric protocols experience similar or higher rates of VTEs as the pediatric ALL population and that the risk of developing a VTE is increased in patients as body mass index (BMI) and asparaginase dose increases. Results: Fourteen patients (21%) experienced 17 VTEs. The majority of VTEs occurred during induction chemotherapy (47%), after asparaginase administration (88%), in the upper extremities (59%), were associated with a CVC (53%), and were treated with anticoagulation (94%). BMI or asparaginase dose during induction chemotherapy were not predictive of VTE risk (p=0.9). There were no statistical differences in age at diagnosis, sex distribution, race/ethnicity distribution, other treatment-related morbidities, relapse-free survival (79% vs 81% at 5 years), and overall survival (93% vs 81% at 5 years) in patients who experienced a VTE compared to controls. Conclusions: AYA patients with ALL experienced similar rates of VTE as their pediatric counterparts. Unlike adults with cancer, increased BMI and asparaginase dose were not associated with an elevated risk of VTE. Given the limited study size and retrospective nature of this study, future prospective studies are indicated before this information is appropriate for clinical application.