V. Mall et al., Effect of glucocorticoids, E. coli- and Erwinia L-asparaginase on hemostatic proteins in children with acute lymphoblastic leukemia, KLIN PADIAT, 211(4), 1999, pp. 205-210
Background: The concentrations of plasma hemostatic proteins were analyzed
prospectively in 42 children with acute lymphoblastic leukemia (ALL), treat
ed according to the protocol ALL-BFM-90.
Procedure: Treatment included glucocorticosteroids (GC), E.coli L-asparagin
ase (Asparaginase(R), Medac) or Erwinia L-asparaginase (Erwinase(R), Speywo
od), vincristine, anthracyclines and intrathecal methotrexate. The analysis
of hemostatic proteins was performed during induction and re-induction the
rapy.
Results: At diagnosis, the plasma concentrations of fibrinogen, antithrombi
n III (AT), plasminogen and protein C were within normal limits, whereas th
e von Willebrand factor antigen (vWF:Ag) was elevated. After eight days of
mono-therapy with GC the concentration of fibrinogen decreased to 59%, vWF:
Ag decreased to 67%, AT increased to 124%,protein C increased to 201% of th
e initial value (mean all p less than or equal to 0.01), while the concentr
ation of plasminogen remained unchanged. During the reinduction phase, the
concentrations of the hemostatic proteins, with exception of vWF:Ag, altere
d in a similar way in response to GC as observed during the induction phase
. Administration of two doses of E.coli L-asparaginase (10,000 U/m(2)) duri
ng the induction therapy led to a significant decrease of AT (123 +/- 24 to
63 +/- 15%/mL), protein C (168 +/- 34 to 87 +/- 19%/mL), plasminogen (94 /- 21 to 41 +/- 12%/mL) and fibrinogen (148 +/- 59 to 79 +/- 30 mg/dL, p le
ss than or equal to 0.01 for all parameters). In contrast, administration o
f two doses of Erwinia L-asparaginase (10,000 U/m(2)) during re-induction t
herapy did not lead to change in the concentration of AT, protein C or plas
minogen, and the decrease in fibrinogen (162 +/- 17 to 121 +/- 24 mg/dL) wa
s less pronounced.
Conclusions: Our results indicate that GC and E.coli L-asparaginase, in par
ticular, induce hemostatic alterations which have implications on our under
standing of thrombotic and hemorrhagic events during the treatment of ALL i
n children.