Cerebrovascular complications of L-asparaginase in the therapy of acute lymphoblastic leukemia.
L-asparaginase is frequently used in combination therapy for the treatment of lymphoid malignancies. We report 5 children aged between 8 and 14 years with neurologic complications presenting with headache and seizures during the first three weeks of L-asparaginase treatment. Three patients had venous thrombosis, one presented a parenchymal hemorrhage, and one showed a peculiar encephalopathy with extended cortical and subcortical lesions suggesting a neurotoxic reaction. Decreased fibrinogen and antithrombin III levels were found. Early MRI is critical even in cases with mild neurologic symptoms. Diagnosis should be followed by early cessation of l-asparaginase application.
Kieslich
Matthias
M
Department of Pediatric Neurology, Johann Wolfgang Goethe University, Theodor Stern Kai 7, 60590 Frankfurt/Main, Germany. matthias.kieslich@kgu.de
Porto
Luciana
L
Lanfermann
Heinrich
H
Jacobi
Gert
G
Schwabe
Dirk
D
Böhles
Hansjosef
H
D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000990:Antithrombin III / Q000378:metabolism; D001215:Asparaginase / Q000009:adverse effects* / Q000627:therapeutic use; D001921:Brain / Q000187:drug effects*; D001927:Brain Diseases / Q000139:chemically induced*; D002543:Cerebral Hemorrhage / Q000139:chemically induced; D002648:Child; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006261:Headache / Q000139:chemically induced; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D012640:Seizures / Q000139:chemically induced; D020246:Venous Thrombosis / Q000139:chemically induced
D000970:Antineoplastic Agents; D000990:Antithrombin III; D005340:Fibrinogen; D001215:Asparaginase