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Influence of two different regimens of concomitant treatment with asparaginase and dexamethasone on hemostasis in childhood acute lymphoblastic leukemia

Leukemia volume 21, pages 2377–2380 (2007)Cite this article

Asparaginase is an important drug in the treatment of childhood acute lymphoblastic leukemia (ALL). Its influence on the coagulation system has been extensively studied.1 Asparaginase is an enzyme leading to serum depletion of asparagine and glutamine. Consequently, protein synthesis is depressed leading to coagulation protein deficiencies as a side effect of antileukemic treatment. The effect on antithrombotic proteins might induce an increased risk for thrombosis, while the effects on procoagulant proteins might increase the bleeding risk. Asparaginase is usually given in combination with other chemotherapeutic drugs among which especially corticosteroids may also influence the coagulation system. Corticosteroids may induce hypofibrinogenemia potentially leading to bleeding, but also increase the risk for thrombotic events by the induction of a hypofibrinolytic state in combination with an increase in procoagulant factors.2 So, in general, it is difficult to analyze which coagulation disorders in children with ALL are due to asparaginase and which are due to concomitant use of other drugs such as corticosteroids. In this study, we analyzed the influence of both these drugs (Paronal and dexamethasone) in one group of children during two different parts of ALL therapy.

Blood samples were collected immediately before each Paronal infusion to analyze procoagulant (fibrinogen, F II, F V, F VII, F IX, F X) and anticoagulant factors (antithrombin, protein C, protein S) and parameters of thrombin generation (F1+2, thrombin–antithrombin (TAT) complex) and fibrinolysis (α2-antiplasmin, plasminogen, plasmin–α2 antiplasmin (PAP) complex, D-dimer).

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  1. Erasmus MC-University Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam, The Netherlands

    I M Appel, C van Kessel-Bakvis, R Stigter & R Pieters

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  1. I M Appel
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  2. C van Kessel-Bakvis
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  3. R Stigter
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  4. R Pieters
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Correspondence to I M Appel.

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Appel, I., van Kessel-Bakvis, C., Stigter, R. et al. Influence of two different regimens of concomitant treatment with asparaginase and dexamethasone on hemostasis in childhood acute lymphoblastic leukemia. Leukemia 21, 2377–2380 (2007). https://doi.org/10.1038/sj.leu.2404793

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