A large multicenter study in pediatric ALL patients showed a significant reduction of VTE with the use of dexamethasone instead of prednisone.22Corticosteroids, especially prednisone, creates a hypercoagulable and hypofibrinolytic state, amplifying the hypercoagulable effect of asparaginase.23, 24, 25Finally, in contrast to the ALL-9 protocol, asparaginase was continued after the induction phase, in the intensification phase of the MR patients, causing another nine patients to develop VTE. Here, ASPG is linked to acute lymphoblastic leukemia.