title: Prophylactic therapy with enoxaparin during L-asparaginase treatment in children with acute lymphoblastic leukemia.
abstract: Forty-one consecutive children with acute lymphoblastic leukemia (ALL) received prophylaxis therapy with the low molecular weight heparin (LMWH) enoxaparin during L-asparaginase treatment. Enoxaparin was given every 24 h subcutaneously at a median dose of 0.84 mg/kg per day (range, 0.45-1.33 mg/kg per day) starting at the first dose of L-asparaginase until 1 week after the last dose. Molecular analysis for thrombophilic polymorphisms documented prothrombin G20210A mutation in 3/27 (11%), homozygosity for MTHFR C677T mutation in 5/27 (18.5%, and heterozygosity for factor V Leiden mutation in 5/27 (18.5%) children. There were no thrombotic events during 76 courses of L-asparaginase in 41 patients who had received enoxaparin. One patient suffered brain infarct 7 days after enoxaparin was stopped. There were no bleeding episodes. In a historical control group of 50 ALL children who had not received prophylactic enoxaparin during L-asparaginase treatment, two had thromboembolisms (one deep vein thrombosis and one pulmonary embolism). Enoxaparin is safe and seems to be effective in prevention of thromboembolism in ALL patients during L-asparaginase therapy. This study provides pilot data for a future randomized trial of the use of LMWH during ALL therapy for the prevention of asparaginase-associated thrombotic events.
authors.affiliation: Department of Pediatric Hemato-Oncology, Rambam Medical Center and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Elhasid
authors.forename: N
authors.initials: N
authors.lastname: Lanir
authors.forename: R
authors.initials: R
authors.lastname: Sharon
authors.forename: M
authors.initials: M
authors.lastname: Weyl Ben Arush
authors.forename: C
authors.initials: C
authors.lastname: Levin
authors.forename: S
authors.initials: S
authors.lastname: Postovsky
authors.forename: A
authors.initials: A
authors.lastname: Ben Barak
authors.forename: B
authors.initials: B
authors.lastname: Brenner
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001215:Asparaginase / Q000008:administration & dosage*; D001779:Blood Coagulation Factors / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D004252:DNA Mutational Analysis; D004359:Drug Therapy, Combination; D017984:Enoxaparin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007557:Israel / Q000453:epidemiology; D008297:Male; D010865:Pilot Projects; D011110:Polymorphism, Genetic; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy* / Q000235:genetics; D013923:Thromboembolism / Q000209:etiology / Q000235:genetics / Q000517:prevention & control*; D019851:Thrombophilia / Q000188:drug therapy / Q000209:etiology / Q000235:genetics
chemical_list: D000925:Anticoagulants; D000970:Antineoplastic Agents; D001779:Blood Coagulation Factors; D017984:Enoxaparin; D001215:Asparaginase