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Published on: October 31, 2012
A prospective longitudinal multicenter study of coagulation in pediatric patients undergoing allogeneic stem cell
Leonardo R Brandão1, Morris Kletzel, Farid Boulad
1Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada. leonardo.brandao@sickkids.ca
Insights
Pediatric stem cell transplant (SCT) patients develop acquired thrombophilia early post-transplant, with decreased protein C and antithrombin levels. These hemostatic changes may be linked to specific transplant factors, though no thrombotic events occurred.
Area of Science:
- Hematology
- Pediatric Oncology
- Transplantation Medicine
Background:
- Thrombotic complications are common in adult stem cell transplant (SCT) recipients.
- Limited data exists on coagulation changes and thrombosis risk in pediatric SCT patients.
Purpose of the Study:
- To prospectively evaluate coagulation status in pediatric allogeneic SCT recipients.
- To identify potential correlations between altered coagulation and SCT-associated thrombosis or organ failure.
Main Methods:
- Prospective evaluation of 43 pediatric SCT subjects.
- Assessed congenital thrombophilia, anticoagulant levels, coagulation activation, and fibrinolysis.
- Monitoring occurred from pre-conditioning to 28 days post-transplantation.
Main Results:
- Significant decreases in protein C (39%) and antithrombin (31%) levels observed early post-SCT.
- Peak plasminogen activator inhibitor-1 levels noted in 31% of subjects.
- No thrombotic events or organ failures occurred; prophylactic heparin showed no impact.
Conclusions:
- Children undergoing allogeneic SCT develop acquired thrombophilia in the early post-transplant period.
- Identified potential clinical triggers for hemostatic changes, including underlying malignancy, HLA-mismatch, and TBI.
- Further evaluation in larger cohorts is needed to confirm findings and clinical significance.
Background:
Thrombotic complications occur in adult patients undergoing stem cell transplantation (SCT), especially following high dose chemo-radiotherapy. There is little published information in children on the impact of SCT on coagulation, as well as potential correlations between altered coagulation and SCT-associated thrombosis and organ failure.
Procedure:
Forty three pediatric subjects who underwent allogeneic SCT were prospectively evaluated for congenital thrombophilia, anticoagulant levels, coagulation activation, and fibrinolysis at pre-established set points encompassing the period from the 2 to 4 weeks prior to conditioning to 28 days post-transplantation.
Results:
A significant decrease of protein C and antithrombin levels was found in 39% and 31% of subjects respectively, between SCT days +6 and +7. A peak in plasminogen activator inhibitor-1 levels in 31% of subjects was noted between days +9 and +10. No subject experienced a thrombotic event or other SCT-related organ failure. Antithrombin deficiency correlated with underlying malignancy, donor HLA-mismatch, and TBI, whereas decreased PC activity demonstrated a trend of association with lack of T-cell depletion and TBI. Prophylactic heparin did not influence the pattern of acquired hemostatic abnormalities observed in this cohort.
Conclusions:
Children undergoing allogeneic SCT develop a state of acquired thrombophilia in the early post-transplantation period. Although no SCT-related thromboembolic events were observed, our results provide new information about the hemostatic changes in children undergoing allogeneic SCT and their potential clinical triggers. The significance of these findings requires further prospective evaluation in a larger cohort of patients.
