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Clotting abnormalities in children during maintenance chemotherapy for acute lymphoblastic leukemia
1Dipartimento di Pediatria, Università di Pavia, IRCCS Policlinico San Matteo, Italy.
Insights
Childhood acute lymphoblastic leukemia (ALL) maintenance chemotherapy can cause mild clotting changes. This study found reduced clotting factors VII, IX, and X, but no increased bleeding risk.
Area of Science:
- Pediatric Hematology
- Oncology
- Pharmacology
Background:
- Childhood acute lymphoblastic leukemia (ALL) treatment involves drugs that can affect organ function.
- A mild delay in prothrombin time was observed in ALL children during maintenance chemotherapy.
Purpose of the Study:
- To investigate the impact of maintenance chemotherapy on blood clotting parameters in children with ALL.
- To identify specific clotting factors affected by the treatment.
Main Methods:
- Studied 17 children with ALL undergoing maintenance chemotherapy.
- Compared clotting function screening in these children against 15 age- and sex-matched healthy controls.
Main Results:
- Observed a consistent pattern of slightly prolonged prothrombin time in ALL children.
- Found significantly reduced levels of clotting factors VII and IX.
- Noted a trend toward reduced activity of factor X, with no anticoagulant factors detected.
Conclusions:
- Maintenance chemotherapy for ALL is linked to subclinical clotting parameter modifications.
- These changes do not lead to hemorrhagic diathesis (bleeding disorders).
- Long-term use of anti-metabolites like 6-mercaptopurine and methotrexate may cause this reversible impairment.
Background:
Many of the drugs used in the treatment of acute lymphoblastic leukemia in children may induce modifications in different organs and functions. Following the observation of a recurrent, mild delay in the prothrombin time in ALL children during maintenance chemotherapy, we explored the main parameters of the clotting function.
Methods:
17 children with acute lymphoblastic leukemia were studied during maintenance chemotherapy for clotting function screening evaluation; 15 healthy children, matched for age and sex, were used as controls.
Results:
A uniform pattern of slight prolongation of the prothrombin time with significantly reduced levels of factors VII, IX, and a trend toward reduced activity of factor X was observed in the absence of any demonstrable anticoagulant factor.
Conclusions:
Antileukemic maintenance chemotherapy is associated with a subclinical modification of the clotting parameters that is not responsible for hemorrhagic diathesis. Long-term administration of anti-metabolites (6-mercaptopurine and methotrexate) could be responsible for this reversible impairment.