静脉血栓栓塞（VTE）是急性淋巴细胞白血病（ALL）患者在使用以天门冬氨酸酶（ASP）为主的化疗方案（包括 ASP 强化 Dana-Farber 癌症研究所（DFCI）91-01 方案）中常见的并发症。自2019年起，加拿大不再提供天然L-ASP，而是替换为聚乙二醇（PEG）-ASP。为了确定自从转用 L-ASP 至 PEG-ASP 后 VTE 发生率是否有所改变，我们进行了单中心的回顾性队列研究。我们纳入了2011年至2021年间的245名无菲拉德尔菜单染色体 ALL 成年患者，其中175名来自 L-ASP 组（2011-2019年），70名来自 PEG-ASP 组（2018-2021年）。在诱导期间，接受 L-ASP 的患者中有10.29%（18/175）发生了 VTE，而接受 PEG-ASP 的患者中有28.57%（20/70）发生了 VTE（p = 0.0035；调整后的多元 logistic 回归分析中，赔率比 [OR] 为 3.35，95% 置信区间 [CI] 为 1.51-7.39），考虑到线路类型、性别、既往 VTE 史和诊断时血小板数。类似地，在加强期间，132名接受 L-ASP 的患者中有13.64%（18/132）发生了 VTE，而32名接受 PEG-ASP 的患者中有34.37%（11/32）发生了 VTE（p = 0.0096；多变量分析中 OR 为 3.96，95% CI 为1.57-9.96）。我们发现相比于 L-ASP，PEG-ASP 在诱导期和加强期都与较高的 VTE 发生率相关，尽管使用了预防性抗凝治疗。对于接受 PEG-ASP 的成年 ALL 患者，需要更多的 VTE 防治策略。© 2023 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.

Venous thromboembolism (VTE) is a well-known complication in patients with acute lymphoblastic leukaemia (ALL) receiving asparaginase (ASP)-based chemotherapy, including the ASP-intensive Dana-Farber Cancer Institute (DFCI) 91-01 protocol for adults. Since 2019, native L-ASP is no longer available in Canada and was replaced by pegylated (PEG)-ASP. To determine whether the incidence of VTE has changed since switching from L-ASP to PEG-ASP, we conducted a single-centred retrospective cohort study. We included 245 adult patients with Philadelphia chromosome negative ALL between 2011 and 2021, with 175 from the L-ASP group (2011-2019) and 70 from the PEG-ASP group (2018-2021). During Induction, 10.29% (18/175) of patients who received L-ASP developed VTE, whereas 28.57% (20/70) of patients who received PEG-ASP developed VTE (p = 0.0035; odds ratio [OR] 3.35, 95% confidence interval [CI] 1.51-7.39), after adjusting for line type, gender, history of VTE, platelets at diagnosis. Similarly, during Intensification, 13.64% (18/132) of patients had VTE on L-ASP while 34.37% (11/32) of patients on PEG-ASP developed VTE (p = 0.0096; OR 3.96, 95% CI 1.57-9.96 with multivariable analysis). We found that PEG-ASP is associated with a higher incidence of VTE compared to L-ASP, both during Induction and Intensification, despite the administration of prophylactic anticoagulation. Further VTE mitigation strategies are needed in particular for adult patients with ALL receiving PEG-ASP.© 2023 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.