Influence of cytostatic treatment on the coagulation system and fibrinolysis in patients with non-Hodgkin's lymphomas and acute leukemias.
Cytostatic therapy is known to aggravate tumor-induced coagulopathy. Therefore, we have studied the effect of different chemotherapeutic regimens on the activation of coagulation and fibrinolysis in patients with non-Hodgkin's lymphomas or acute leukemias. In non-Hodgkin's lymphoma patients treated with an aggressive protocol (COL-BLAM) and in leukemia patients (TAD-9) fibrinopeptide A, prothrombin fragment (F1 + 2) and thrombin antithrombin III complexes (TAT) increased (Tables 4 and 6), while D-dimer did not deviate significantly. The ratio D-dimer/TAT consequently showed a significant decrease, indicating increased formation of thrombin after release of procoagulant factors, which is not paralleled by an activation of fibrinolysis. Both these groups were also characterized by an increase in uric acid and in C-reactive protein and plasminogen-activator inhibitor, two acute-phase reactants. In contrast, patients with non-Hodgkin's lymphomas treated with a less aggressive protocol (COP) showed no significant changes in hemostatic variables, uric acid, or acute-phase reactants. The release of procoagulant factors relates to the cytostatic sensitivity of the tumor and to a high tumor-cell destruction. Our results further emphasize the need for large-scale studies on antithrombotic prophylaxis in patients undergoing cytostatic treatment.
Zurborn
K H
KH
First Department of Internal Medicine, University of Kiel, Germany.
Gram
J
J
Glander
K
K
Delbrück
K
K
Pelzer
H
H
Löffler
H
H
Bruhn
H D
HD
D000208:Acute Disease; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000990:Antithrombin III / Q000032:analysis; D001761:Bleomycin / Q000627:therapeutic use; D001777:Blood Coagulation / Q000187:drug effects*; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005342:Fibrinolysis / Q000187:drug effects*; D005344:Fibrinopeptide A / Q000032:analysis; D006801:Humans; D007938:Leukemia / Q000097:blood* / Q000188:drug therapy; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000188:drug therapy; D008228:Lymphoma, Non-Hodgkin / Q000097:blood* / Q000188:drug therapy; D010447:Peptide Hydrolases / Q000032:analysis; D011241:Prednisone / Q000627:therapeutic use; D011344:Procarbazine / Q000627:therapeutic use; D014750:Vincristine / Q000627:therapeutic use
D000970:Antineoplastic Agents; C046193:antithrombin III-protease complex; D001761:Bleomycin; D005344:Fibrinopeptide A; D011344:Procarbazine; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D000990:Antithrombin III; D010447:Peptide Hydrolases; D011241:Prednisone