Anticoagulation Prophylaxis With Enoxaparin For Patients With Acute Lymphoblastic Leukemia Receiving Asparaginase-Based Intensification Therapy
Bibliographic record
Abstract
Abstract Background Venous thromboembolism (VTE) is a well-known complication in patients treated with asparaginase-containing regimens; the optimal preventative strategy is unclear. We assessed the safety and efficacy of low-dose low molecular weight heparin (LMWH) prophylaxis in adult patients with newly diagnosed acute lymphoblastic leukemia (ALL) treated with an asparaginase- based regimen. Methods Patients were treated with the DFCI 91-01 protocol from 2009-2012; patients age 60 and over received a modified version. All patients who were in complete remission and received at least 7 cycles (21 weeks) of the asparaginase-based intensification phase were evaluable for analysis. Patients already on anticoagulation for prior VTE were excluded. Patients received enoxaparin subcutaneously once daily, at a dose of 40 mg for patients weighing less than 80 kg and 60 mg for those 80 kg and over, beginning on day 1, cycle 1 of intensification until the completion of the entire 21-30 week intensification phase. Results were compared to a similar cohort of consecutive patients treated with the same protocol prior to 2009, without anticoagulation prophylaxis. Results There were 41 evaluable patients who received enoxaparin prophylaxis. The historical cohort (n=99) did not significantly differ from this group with respect to median age, weight and number of treatment cycles per patient. The mean enoxaparin dose administered was 0.62 mg/kg (range 0.39-1.05 mg/kg). As shown in Table 1, the overall rate of VTE was not significantly different than the historical non-prophylaxed cohort. Among patients receiving prophylaxis, there was a higher rate of VTE in patients who weight at least 80 kg, despite the higher enoxaparin dose used (p=0.036). There was no significant difference in the rate of VTE according to age or gender. Sites of VTE in the prophylaxed group included lower extremity (8 cases), sagittal sinus (2), subclavian line related (2), and pulmonary embolism (6). There were no major bleeding complications observed in the prophylaxed group (minor bleeding 3/41). Conclusions Prophylaxis with low-dose enoxarain during the intensification phase was safe, but did not show a significant benefit in reducing the rate of VTE. Prospective randomized studies are needed, using more intensive or novel prophylaxis strategies, in adult ALL patients treated with asparaginase-containing regimens. Disclosures: Off Label Use: enoxaparin for VTE prophylaxis in ALL.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".