Introduction:
Leukemia is the most common childhood cancer today, representing 25% of all childhood cancers. Acute lymphoblastic leukemia (ALL) is the most common type of childhood leukemia. Cure rates for children with ALL have currently reached 90% following multi-agent intensive chemotherapy [1]. Today, efforts are directed towards controlling the toxicities that result from such aggressive therapies that can lead to serious complications and thus treatment cessation.
Cerebral Sinus Venous Thrombosis (CSVT) is one of many side effects encountered during ALL therapy. CSVT was shown to complicate therapy in 1-2% of children being treated for ALL [2]. In childhood, CSVT has a mortality rate of 8-13% [2] and can cause serious neurological morbidity. In addition, CSVT was shown to compromise ALL therapy by a reluctance to interrupt anticoagulation for intrathecal treatment and/ or delayed/missed doses of L-asparaginase due to concern about thrombus progression or recurrence [3]. Thus, CSVT development during ALL therapy is not only limited to its own complications but extends to its potential negative impact on treatment, which makes it a rare but serious complication. There is still no consensus in the literature regarding identification of high-risk groups, potential risk factors, and prophylaxis.
Moreover, the most recent guidelines for the management of venous thromboembolism in pediatric population did not find enough accord in the literature to recommend CSVT prophylaxis in children being treated for ALL.
The aim of this manuscript is to explore potential risk factors for the development of CSVT in children with ALL undergoing treatment and to augment our previous findings (Ghanem et al,) with additional risk factors based on a larger and more representative sample.