Venous thromboembolism and its risk factors in children with acute lymphoblastic leukemia in israel: A population-based study

Shlomit Barzilai-Birenboim*, Ronit Nirel, Nira Arad-Cohen, Galia Avrahami, Miri Ben Harush, Assaf Arie Barg, Bella Bielorai, Ronit Elhasid, Gil Gilad, Amos Toren, Sigal Weinreb, Shai Izraeli, Sarah Elitzur

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Venous thromboembolism (VTE) is a serious complication of acute lymphoblastic leukemia (ALL) therapy. The aim of this population-based study was to evaluate the rate, risk factors, and long-term sequelae of VTE in children treated for ALL. The cohort included 1191 children aged 1–19 years diagnosed with ALL between 2003–2018, prospectively enrolled in two consecutive protocols: ALL-IC BFM 2002 and AIEOP-BFM ALL 2009. VTEs occurred in 89 patients (7.5%). Long-term sequelae were uncommon. By univariate analysis, we identified four significant risk factors for VTEs: Severe hypertriglyceridemia (p = 0.005), inherited thrombophilia (p < 0.001), age >10 years (p = 0.015), and high-risk ALL group (p = 0.039). In addition, the incidence of VTE was significantly higher in patients enrolled in AIEOP-BFM ALL 2009 than in those enrolled in ALL-IC BFM 2002 (p = 0.001). Severe VTE occurred in 24 children (2%), all of whom had at least one risk factor. Elevated triglyceride levels at diagnosis did not predict hypertriglyceridemia during therapy. In a multivariate analysis of 388 children, severe hypertriglyceridemia and inherited thrombophilia were independent risk factors for VTE. Routine evaluation for these risk factors in children treated for ALL may help identify candidates for intervention.

Original languageAmerican English
Article number2759
Pages (from-to)1-15
Number of pages15
Issue number10
StatePublished - Oct 2020

Bibliographical note

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© 2020 by the authors. Licensee MDPI, Basel, Switzerland.


  • Acute lymphoblastic leukemia
  • Hypertriglyceridemia
  • Risk factors
  • Sinus vein thrombosis
  • Thrombophilia
  • Venous thromboembolism

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