Alterations in Procoagulant, Anticoagulant, and Fibrinolytic Systems Before and After Start of Induction Chemotherapy in Children With Acute Lymphoblastic Leukemia

Induction chemotherapy is associated with increased thrombosis risk in children with acute lymphoblastic leukemia (ALL). In this prospective study, we explored the effects of ALL and induction chemotherapy on the procoagulant, anticoagulant, and fibrinolytic systems in 20 children with ALL. The leve...

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Bibliographic Details
Published in:Clinical and applied thrombosis/hemostasis 2013-11, Vol.19 (6), p.644-651
Main Authors: Albayrak, Meryem, Gürsel, Turkiz, Kaya, Zuhre, Koçak, Ülker
Format: Article
Language:English
Subjects:
Adolescent
Anticoagulants
Anticoagulants - therapeutic use
Antineoplastic Combined Chemotherapy Protocols - administration & dosage
Antineoplastic Combined Chemotherapy Protocols - adverse effects
Blood Coagulation - drug effects
C-Reactive Protein - metabolism
Carboxypeptidase B2 - pharmacology
Carboxypeptidase B2 - therapeutic use
Chemotherapy
Child
Child, Preschool
Female
Fibrinolysis - drug effects
Health risk assessment
Humans
Induction Chemotherapy
Leukemia
Male
Precursor Cell Lymphoblastic Leukemia-Lymphoma - blood
Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy
Risk Factors
Thrombosis - blood
Thrombosis - pathology
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Summary:Induction chemotherapy is associated with increased thrombosis risk in children with acute lymphoblastic leukemia (ALL). In this prospective study, we explored the effects of ALL and induction chemotherapy on the procoagulant, anticoagulant, and fibrinolytic systems in 20 children with ALL. The levels of d-dimer, factor VIII, von Willebrand factor, protein C, antithrombin III, and thrombin-activated fibrinolysis inhibitor (TAFI) were elevated at diagnosis. These changes were not related with peripheral blast count. The levels of fibrinogen, d-dimer, coagulation inhibitors, and plasminogen decreased, whereas the levels of tissue factor pathway inhibitor and plasminogen activator inhibitor 1 increased progressively following prednisolone monotherapy, administration of vincristine plus daunorubicin, and l-asparaginase. The levels of factor VIII, d-dimer, and TAFI remained elevated during the study period. In conclusion, coagulation activation and impaired fibrinolysis already exist at diagnosis, whereas induction chemotherapy leads to reactivation of coagulation and progressive impairment in fibrinolytic and anticoagulant capacities in childhood ALL.
ISSN:1076-0296
1938-2723
DOI:10.1177/1076029612450771