title: L-Asparaginase and the effect of age on coagulation and fibrinolysis in childhood acute lymphoblastic leukemia.
abstract: Alterations in haemostasis are frequently observed in children with acute lymphoblastic leukemia (ALL). It was the objective of this study to analyse age-related disturbances in coagulation and fibrinolysis parameters during the induction phase of the antileukemic treatment. Sixty-four children were classified by age into three groups (1-5, 6-10, 11-16 years), and studied during induction treatment of ALL including four weeks of dexamethasone, followed by two weeks tapering of dexamethasone during which 6,000 IU/m(2) native L-Asparaginase (total 4 doses) was administered intravenously twice weekly. Blood samples were collected immediately before each L-Asparaginase infusion to analyze procoagulant (fibrinogen, factor [F] II, FV, FVII, F IX, F X) and anticoagulant factors (antithrombin [AT], protein C, protein S), parameters of thrombin generation (F1+2, TAT) and fibrinolysis (alpha2-antiplasmin, plasminogen, PAP, D-dimer). Children were in a hypercoagulable state after four weeks of dexamethasone due to upregulation of coagulation parameters. Upregulation was highest in the two youngest age groups. During L-Asparaginase treatment the 11- to 16-year-olds showed lower values in procoagulant and, even more, in anticoagulant factor levels compared to the younger children. Activation markers of thrombin generation and fibrinolysis did not change over time during the study period. Decreased synthesis of alpha2-antiplasmin and plasminogen during L-Asparaginase treatment resulted in less potential of clot lysis by plasmin in children older than 11 years of age. In conclusion, a more severe decline of anticoagulant and fibrinolytic parameters in children between 11 and 16 years of age underline that these children are at higher risk of thrombosis during ALL induction treatment.
authors.affiliation: Department of Pediatrics, Div. Oncology/Hematology, Erasmus MC/ Sophia Children's Hospital, Rotterdam, The Netherlands. i.m.appel@erasmusmc.nl
authors.forename: Inge M
authors.initials: IM
authors.lastname: Appel
authors.forename: Wim C J
authors.initials: WC
authors.lastname: Hop
authors.forename: Carla
authors.initials: C
authors.lastname: van Kessel-Bakvis
authors.forename: Rolinda
authors.initials: R
authors.lastname: Stigter
authors.forename: Rob
authors.initials: R
authors.lastname: Pieters
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000925:Anticoagulants / Q000378:metabolism; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000009:adverse effects; D001215:Asparaginase / Q000008:administration & dosage*; D001777:Blood Coagulation / Q000187:drug effects*; D001779:Blood Coagulation Factors / Q000378:metabolism; D001780:Blood Coagulation Tests; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects*; D006801:Humans; D007223:Infant; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D012307:Risk Factors; D013917:Thrombin / Q000378:metabolism; D013927:Thrombosis / Q000139:chemically induced / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000925:Anticoagulants; D018931:Antineoplastic Agents, Hormonal; D001779:Blood Coagulation Factors; D003907:Dexamethasone; D013917:Thrombin; D001215:Asparaginase