L-asparaginase-induced coagulopathy in children with acute lymphoblastic leukaemia

Area of Science:

• Pediatric Oncology
• Hematology
• Pharmacology

Background:

• Acute lymphoblastic leukemia (ALL) treatment often involves combination chemotherapy.
• Vincristine (VCR), prednisone (PDN), and L-asparaginase (L-ase) are commonly used agents in ALL therapy.
• These agents can induce significant hemostatic alterations.

Purpose of the Study:

• To prospectively evaluate the hemostatic changes induced by VCR, PDN, and L-ase in children with ALL.
• To identify the predominant clinical manifestation of L-ase-induced coagulopathy in this context.

Main Methods:

• Prospective evaluation of 53 children with ALL undergoing treatment with VCR, PDN, and L-ase.
• Monitoring of coagulation parameters including fibrinogen (FG), prothrombin time (PT), and activated partial thromboplastin time (APTT).
• Assessment of factor VIII concentration and clinical complications.

Main Results:

• Significant decrease in mean FG concentration within the first week, reaching a minimum by the third week.
• Prolongation of PT during the initial weeks of induction therapy.
• Significant decrease in APTT in the final week and post-L-ase cessation.
• Elevated mean factor VIII concentration throughout L-ase therapy.
• Cerebral thrombo/hemorrhagic complications occurred in 3 children (5.6%).

Conclusions:

• Chemotherapy with VCR, PDN, and L-ase induces significant hemostatic changes in children with ALL.
• L-asparaginase-induced coagulopathy, in combination with VCR and PDN, predominantly manifests as a tendency towards thrombosis.
• Close monitoring for thromboembolic events is crucial in pediatric ALL patients receiving this regimen.