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Related Experiment Videos

Changes in hypercoagulability by asparaginase: a randomized study between two asparaginases.

Inge M Appel1, Wim C J Hop, Rob Pieters

  • 1Department of Pediatrics, Division of Oncology/Hematology, Erasmus MC/Sophia Children's Hospital, Rotterdam, The Netherlands. i.m.appel@erasmusmc.nl

Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis
|February 16, 2006
PubMed
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Native Escherichia coli L-asparaginase significantly decreased key clot-inhibiting proteins, increasing thrombosis risk in children with acute lymphoblastic leukemia. Erwinia-derived L-asparaginase did not show these effects.

Area of Science:

  • Hematology
  • Pediatric Oncology
  • Pharmacology

Background:

  • Alterations in hemostasis are common in pediatric acute lymphoblastic leukemia (ALL).
  • Thrombotic events are a known complication of L-asparaginase chemotherapy.
  • Pre-existing hypercoagulability is observed in ALL patients undergoing induction therapy.

Purpose of the Study:

  • To compare the effects of two L-asparaginase preparations on hypercoagulability parameters in pediatric ALL patients.
  • To evaluate changes in thrombin generation, fibrinolysis, and coagulation inhibitors.

Main Methods:

  • Prospective, randomized study involving 20 pediatric ALL patients.
  • Patients received either native Escherichia coli L-asparaginase (n=10) or Erwinia chrysanthemi L-asparaginase (n=10).

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  • Dosing: 10,000 IU/m2 intravenously every 3 days for eight doses during induction therapy.

    • Main Results:

    • Both groups showed elevated prothrombin fragment 1+2 and thrombin antithrombin III before treatment.
    • Native E. coli L-asparaginase significantly decreased alpha2-antiplasmin and plasminogen levels.
    • Erwinase treatment did not result in a significant decrease in these fibrinolytic parameters.

    Conclusions:

    • Native E. coli L-asparaginase may increase thrombosis risk by impairing fibrin elimination.
    • Erwinase appears to have a more favorable hemostatic profile in pediatric ALL patients.
    • Further investigation into L-asparaginase-specific effects on coagulation is warranted.