[Management of venous thromboembolism in children with acute lymphoblastic leukemia: Recommendations from the harmonization workshops of the Leukemia Committee of the French Society for Childhood Cancer (SFCE)].

The recommendations issued by the SFCE harmonization workshop aim to standardize the management of venous thromboembolism (VTE) in children treated for acute lymphoblastic leukemia (ALL). They are based on a review of literature or expert consensus. Routine screening for inherited thrombophilia is not recommended. It should be restricted to children with an unexplained personal history of VTE or a first-degree family history of inherited thrombophilia. When indicated, thrombophilia testing should be targeted (protein C, protein S, antithrombin, factor V Leiden and prothrombin G20210A polymorphisms) and performed outside periods of asparaginase exposure. Primary VTE prophylaxis is not recommended routinely. However, it may be considered during the induction phase in high-risk subgroups (T-cell ALL, adolescents older than 10years, overweight patients), particularly when multiple risk factors are present. Low-molecular-weight heparins (LMWH) at prophylactic doses are recommended as the first-line strategy. Direct oral anticoagulants (DOACs) may be considered in cases of poor tolerance or refusal of injections, although their use remains off-label in this setting. In the event of VTE, LMWH is recommended as first-line therapy. Transition to oral DOACs may be considered in clinically stable patients after at least five days of heparin therapy. The duration and modalities of anticoagulant treatment, as well as the need for secondary prophylaxis, should be tailored to the site of thrombosis, its clinical and radiological evolution, and ongoing exposure to asparaginase.