{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:23:35Z","timestamp":1782779015859,"version":"3.54.5"},"reference-count":22,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2017,6,29]],"date-time":"2017-06-29T00:00:00Z","timestamp":1498694400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Cerebral sinus venous thrombosis (CSVT) is a rare but serious complication of childhood acute lymphoblastic leukemia (ALL) therapy. No available consensus exists regarding its risk factors and appropriate management due to the rarity of cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedures<\/jats:title><jats:p>Out of 209 ALL patients aged 1\u201321 years treated at the Children's Cancer Center of Lebanon between May 2002 and May 2015, 13 developed CSVT during therapy. Patient characteristics, clinical management, and outcomes were studied.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The incidence of CSVT was 6.2% (95% confidence interval [CI]: 3.4\u201310.4). Using univariate analysis, increased risk of CSVT was observed with age &gt;10 years (odds ratio [OR]: 3.56, 95% CI: 1.13\u201311.2), T\u2010cell immunophenotype (OR: 4.14, 95% CI: 1.16\u201314.7), and intermediate\/high risk disease (OR: 3.4, 95% CI: 1.03\u201311.7). The only statistically significant risk factor by multivariate analysis was the treatment as per the intermediate\u2010\/high\u2010risk protocol (HR: 15.6, 95% CI: 1.43\u2013171.3). Most cases (77%) occurred in the postinduction phases of treatment while receiving a combination of asparaginase and dexamethasone rather than prednisone. Treatment with low molecular weight heparin (LMWH) for a minimum of 3 months and until significant radiological improvement is observed resulted in 100% survival rate. All but one patient had complete neurological recovery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>CSVT is an important complication of childhood ALL therapy. Postinduction combined asparaginase and dexamethasone intensive treatment for intermediate\u2010\/high\u2010risk patients was the most important risk factor. Treatment with LMWH for a minimum of 3 months, and until asparginase therapy is over, with major radiological improvement seems to be effective and feasible.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.26694","type":"journal-article","created":{"date-parts":[[2017,6,29]],"date-time":"2017-06-29T08:36:40Z","timestamp":1498725400000},"source":"Crossref","is-referenced-by-count":48,"title":["Cerebral sinus venous thrombosis during childhood acute lymphoblastic leukemia therapy: Risk factors and management"],"prefix":"10.1002","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3601-2244","authenticated-orcid":false,"given":"Khaled M.","family":"Ghanem","sequence":"first","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Hematology Oncology Service, Children's Cancer Center of Lebanon American University of Beirut  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raghida M.","family":"Dhayni","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Hematology Oncology Service, Children's Cancer Center of Lebanon American University of Beirut  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Al\u2010Aridi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Hematology Oncology Service, Children's Cancer Center of Lebanon American University of Beirut  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nidale","family":"Tarek","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Hematology Oncology Service, Children's Cancer Center of Lebanon American University of Beirut  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hani","family":"Tamim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine American University of Beirut  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony K. C.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Thrombosis and Atherosclerosis Research Institute McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raya","family":"Saab","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Hematology Oncology Service, Children's Cancer Center of Lebanon American University of Beirut  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel R.","family":"Abboud","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Hematology Oncology Service, Children's Cancer Center of Lebanon American University of Beirut  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan","family":"El\u2010Solh","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Hematology Oncology Service, Children's Cancer Center of Lebanon American University of Beirut  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samar A.","family":"Muwakkit","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Hematology Oncology Service, Children's Cancer Center of Lebanon American University of Beirut  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,6,29]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.3109\/08880018.2011.578705"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2006-04-015511"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.13162"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0900386"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.23222"},{"key":"e_1_2_9_7_1","article-title":"Cerebral sinovenous thrombosis in children and young adults with acute lymphoblastic leukaemia\u2014a cohort study from the United Kingdom","author":"Musgrave KM","year":"2016","journal-title":"Br J Haematol"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/380681"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/GIM.0b013e3181faa0f2"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0037-1613280"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2002-06-1901"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.13.8404"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/08880010050211376"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2010.08446.x"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPH.0000000000000333"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2010.08132.x"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V97.5.1211"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2009.07820.x"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/1076029611412366"},{"issue":"5","key":"e_1_2_9_20_1","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.1182\/blood.V93.5.1595","article-title":"Prospective evaluation of the thrombotic risk in children with acute lymphoblastic leukemia carrying the MTHFR TT 677 genotype, the prothrombin G20210A variant, and further prothrombotic risk factors","volume":"93","author":"Nowak\u2010Gottl U","year":"1999","journal-title":"Blood"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-01-263012"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.11042"},{"issue":"1","key":"e_1_2_9_23_1","first-page":"39","article-title":"Optimal management of venous thromboembolism in adolescent and young adult oncology patients","volume":"6","author":"McKillop S","year":"2016","journal-title":"Clinical Oncology in Adolescents and Young Adults"}],"container-title":["Pediatric Blood &amp; 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