Graduation Date

Summer 8-13-2021

Document Type


Degree Name

Master of Science (MS)


Cancer Research

First Advisor

Vijaya R Bhatt MD; MS

Second Advisor

Lynette Smith PhD

Third Advisor

Apar Kishor Ganti MD; MS


The outcomes of pediatric acute lymphoblastic leukemia (ALL) have improved dramatically after intensification of the multi-agent chemotherapy backbone over a period of time starting from 1960’s, and asparaginase (ASP) is an important part of this success story. Adoption of such strategy in adult ALL and other high grade lymphoid neoplasms had been difficult due to higher anticipated toxicities including thrombosis. Many thrombosis prevention strategies including antithrombin (AT) replacement, Enoxaparin, unfractionated heparin (UFH) was studied but there is no firmly established evidence-based approach yet. We report the safety and efficacy of thrombosis prophylaxis with apixaban 2.5 mg orally twice daily for up to 3 weeks starting on the first day of receiving ASP. Characteristics of the 20 patients treated with ASP between the years 2017-2020 included a median age of 29.5 years (range 19-63 years), 80% male, 70% whites. Indication for ASP was ALL in 90%. A total of 75% received cryoprecipitate with a median of 10 units (range 0-105 units) in a 4-week period following ASP. The total incidence of thrombosis was 10% and 5% incidence while on anticoagulation. The incidence of major bleeding was 5% while on anticoagulation with apixaban. In conclusion, our study demonstrates the safety of using apixaban for thrombosis prophylaxis and concurrent cryoprecipitate.

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