Is native E coli- or Peg-ASP more thrombogenic in adult ALL? A systematic review and meta-analysis

Summary/background

Native Ecoli-Asparaginase (NEA)-containing regimens is an integral part of the ALL-treatment protocol for pediatric and young adults. By observation, polyethylene glycol-asparaginase (PEG-a) recipients have experienced heightened rates of thrombosis. We conducted a meta-analysis investigating which ASP formulation, instigated thrombosis more intensely. We examined potential risk factors and whether LMWH intervention influence VTE prevention.

Methods

209 studies were reviewed and analyzed. 18 PEG-a- and 15 NEA-containing studies are selected. Of these, 23 Non-LMWH and 10 LMWH thromboprophylaxis interventions are used for VTE rates comparison. One single-center and four comparative studies sought to determine the impact of LMWH on VTE prevention.

Results

The combined data set indicated a significantly higher proportion of VTE incidences in the PEG-a population compared to the NEA recipients. The non-LMWH study data showed a significantly higher proportion of VTE incidences in the PEG-a recipients. In the LMWH-containing data, PEG-a recipients had only slightly higher VTE outcome. LMWH has a favorable effect on VTE prevention as shown by the Forest plot. ASPs exposure and age ≥10 years ranked high-risk for VTE.

Conclusion

PEG-a- compared to NEA-treated adult patients are at significantly higher risk of developing VTE. LMWH demonstrated a protective effect on VTE prevention.