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.