Venous thromboembolic disease in pediatric malignancies Epidemiology and prevention

Over the past decades, survival rates for pediatric cancer increased tremendously. This improvement can be attributed to more insight in the pathogenesis and optimized treatment strategies. However, a potential drawback of these treatment regimens is the burden of toxic effects. Venous thromboembolism is one of these toxic effects and a serious complication of cancer. VTE is a disease in which a blood clot forms within a vein. However, the incidence, risk factors and recurrence rate of VTE in pediatric cancer patients are largely unknown. VTE can lead to suboptimal ALL therapy, due to the need to interrupt, delay or discontinue chemotherapy, and thereby to inferior disease outcomes. This thesis focuses on the epidemiology, treatment and prevention of venous thrombosis in pediatric oncology patients. The first part the role of inherited thrombophilic disorders in the development of pediatric venous thromboembolism is described.
Part II investigated the incidence, risk factors and recurrence rate of venous thromboembolism in pediatric oncology patients. A special focus was on identification of risk factors for VTE in acute lymphoblastic leukemia patients, as well as the influence of VTE on treatment and outcome of acute lymphoblastic leukemia.
The last part focused on treatment and prevention of VTE. The optimal dosage of low-molecular-weight heparin (LMWH) for treatment and prevention was studied. Furthermore different preventive antithrombotic measures were evaluated.
This thesis aimed to provide insight in risk factors and effective antithrombotic strategies in pediatric oncology patients.