[Coagulation disorders during treatment with l-asparaginase preparations]

Coagulation disturbances are noticed, during ALL treatment with L-asparaginase, carrying risk of clotting complications. We examined 38 children with ALL (20 boys and 18 girls) aged 2-16 y., treated in 1996-1997 y. according to BFM and New York programmes. They received L-asparaginase of 10,000 and 25,000 U/m2 per dose at the beginning of induction therapy. The therapy started with E.coli L-asparaginase; in 16 cases the drug was changed to Erwinase. Decreasing of fibrinogen, antithrombin III concentration and prothrombin time was noticed. Infectious complications were established in 8 and clotting problems in 3 children. Substitution with antithrombin III was introduced in 15, with fibrinogen in 17 children because of low plasma concentration. In 21 patients treatment modifications according to decreasing of clotting factors concentration were done. Clotting problems strongly influence the treatment of children with ALL. Substitution therapy may improve the effectiveness of therapy.