Hemostatic changes in children with acute lymphoblastic leukemia treated according to two different L-asparaginase schedules.
Hemostatic changes in 20 children with acute lymphoblastic leukemia (ALL) who were induced with L-asparaginase (L-asp), vincristine (VCR), and prednisone (PDN) (Group A) were prospectively evaluated. These data were compared with those of a previous group of ALL patients who received L-asp as a single agent during consolidation (Group B). In Group A patients, mean plasma antithrombin activity decreased in the first 2 weeks, though not significantly. Relative to pretreatment values, mean fibrinogen concentration diminished particularly by week 3 (p less than 0.001). Activated partial thromboplastin time (APTT) decreased in the last week as well as after cessation of therapy with L-asp (p less than 0.05). Mean platelet count increased significantly by week 3 (p less than 0.05). Thromboelastograms performed in seven patients confirmed the tendency for thrombosis evidenced by a decreased APTT. Patients in Group B (L-asp alone during consolidation) had decreased concentrations of fibrinogen, AT, and Factors IX and X after L-asp therapy. APTT was prolonged. Our data demonstrate that the tendency for thrombosis is the predominant manifestation of L-asp induced coagulopathy, when the drug is associated with VCR and PDN. Thus the risk/benefit ratio for the use of L-asp early in induction in children with low risk ALL needs to be further evaluated.
Miniero
R
R
Pastore
G
G
Saracco
P
P
Messina
M
M
Lange
M M
MM
Fiandino
G
G
Iannacci
L
L
Madon
E
E
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000991:Antithrombins / Q000032:analysis; D001215:Asparaginase / Q000008:administration & dosage / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006487:Hemostasis / Q000187:drug effects*; D006801:Humans; D007223:Infant; D007945:Leukemia, Lymphoid / Q000097:blood* / Q000188:drug therapy; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D010314:Partial Thromboplastin Time; D010976:Platelet Count / Q000187:drug effects; D011241:Prednisone / Q000008:administration & dosage; D011446:Prospective Studies; D011517:Prothrombin Time; D012016:Reference Values; D013918:Thrombin Time; D014750:Vincristine / Q000008:administration & dosage
D000991:Antithrombins; D014750:Vincristine; D005340:Fibrinogen; D001215:Asparaginase; D011241:Prednisone; D008727:Methotrexate