Objective:

To characterize cerebrovascular thrombosis occurring during chemotherapy for pediatric acute lymphoblastic leukemia (ALL) by integrating clinical presentation, laboratory coagulation profiles, neuroimaging findings, treatment approaches, and long-term neurological outcomes.

Approach:

Key Findings:

• Among 1,138 pediatric patients with ALL, six developed cerebrovascular thrombosis (incidence proportion, 0.53%).
• Five patients had cerebral venous sinus thrombosis (CVST) and one had acute ischemic stroke (AIS).
• Most events occurred 5–17 days after PEG-asparaginase administration.
• Patients exhibited elevated D-dimer levels and reduced antithrombin III (AT-III) activity at symptom onset.
• Therapeutic low-molecular-weight heparin was administered to four patients with CVST, leading to favorable outcomes.

Interpretation:

Cerebrovascular thrombosis during pediatric ALL therapy is associated with a distinct temporal pattern following PEG-asparaginase exposure, characterized by coagulation abnormalities.

Limitations:

• Small sample size limits generalizability.
• Single-center study may not reflect broader population.

Conclusion:

The study highlights a high-risk period for cerebrovascular thrombosis following PEG-asparaginase exposure, suggesting the need for focused coagulation monitoring.

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