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Disseminated intravascular coagulation in childhood acute lymphocytic leukemia with poor prognostic features
Insights
Disseminated intravascular coagulation (DIC) occurred in children with acute lymphoblastic leukemia (ALL) and poor prognostic indicators. Careful coagulation monitoring and modified L-asparaginase therapy are recommended for these high-risk leukemia patients.
Area of Science:
- Pediatric Hematology Oncology
- Hematologic Malignancies
- Coagulation Disorders
Background:
- Acute lymphoblastic leukemia (ALL) is the most common childhood cancer.
- Disseminated intravascular coagulation (DIC) is a rare but serious complication in pediatric ALL.
- Poor prognostic features in ALL necessitate careful management and monitoring.
Observation:
- Three pediatric patients with ALL and poor prognostic features presented with clinical and laboratory evidence of DIC.
- Two patients developed bleeding complications during induction chemotherapy, coinciding with a rapid decrease in blast cell counts.
- One patient experienced superficial thrombophlebitis linked to leukemia relapses and rising blast counts.
Findings:
- The study highlights an unusual association between ALL and DIC, particularly in patients with adverse prognostic markers.
- Chemotherapy adjustments, including withholding L-asparaginase and heparin treatment, were effective in managing DIC episodes.
- Chromosomal evaluation is suggested for leukemic patients resembling ALL but potentially having other subtypes.
Implications:
- This case series suggests a need for vigilant coagulation monitoring in pediatric ALL patients with poor prognostic signs.
- Modified therapeutic strategies, including cautious use of L-asparaginase, may improve outcomes.
- Further research into the mechanisms of DIC in ALL and the role of chromosomal analysis is warranted.
Abstract:
Three children with ALL having poor prognostic features developed clinical and laboratory evidence of disseminated intravascular coagulation (DIC). Two developed a bleeding diathesis associated temporally with a rapid drop in blast cell counts during induction therapy with L-asparaginase, prednisone, and vincristine. One of these children died of massive cerebral hemorrhage. The third patient developed episodes of superficial thrombophlebitis associated with relapses and rising blast cell counts which responded to chemotherapy and treatment with heparin. The unusual association of ALL with DIC and the fact that all 3 patients had multiple poor prognostic signs have led us to monitor carefully the coagulation system and withhold L-asparaginase in patients with massive disease until the white cell count and organomegaly have responded to prednisone and vincristine. The more common association of DIC with non-lymphocytic leukemia and recent reports of the presence of the Ph' chromosome in children with leukemia morphologically resembling ALL suggest that chromosomal evaluation be done in selected leukemic patients.