Prospective study of hemostatic alterations in children with acute lymphoblastic leukemia

Autor: Nicoletta Crescenzio, Anna Falanga, Giovanna Russo, Giovanni Carlo Del Vecchio, Paolo Perutelli, Marina Marchetti, Paola Saracco, Maria Altomare, Angelo Claudio Molinari, Nicola Santoro, Paola Giordano, Domenico De Mattia
Jazyk: angličtina
Rok vydání: 2010
Předmět:
Male
medicine.medical_treatment
Fibrinogen
Gastroenterology
bambini
chemistry.chemical_compound
Risk Factors
Antineoplastic Combined Chemotherapy Protocols
Thrombophilia
Longitudinal Studies
Prospective Studies
Child
acute lymphoid leukemia
leucemia acuta linfoide
biology
Mercaptopurine
Antithrombin
Cytarabine
Thrombin
Hematology
Venous Thromboembolism
Precursor Cell Lymphoblastic Leukemia-Lymphoma
P-Selectin
Vincristine
Plasminogen activator inhibitor-1
Child
Preschool
Female
medicine.drug
medicine.medical_specialty
Adolescent
coagulazione
Fibrin
Antithrombins
Fibrin Fibrinogen Degradation Products
Von Willebrand factor
children
Internal medicine
Acute lymphocytic leukemia
Fibrinolysis
Plasminogen Activator Inhibitor 1
von Willebrand Factor
medicine
Asparaginase
Humans
coagulation
Cyclophosphamide
business.industry
Daunorubicin
Infant
medicine.disease
Methotrexate
chemistry
Hemostasis
Case-Control Studies
Immunology
biology.protein
Prednisone
business
Popis: In a group of newly diagnosed acute lymphocytic leukemia (ALL) children we evaluated a number of hemostatic and inflammatory markers at diagnosis and at different time points during chemotherapy for the remission induction to identify alterations in the plasma levels of prothrombotic markers before and during the course of chemotherapy. The following plasma markers were evaluated: thrombin-antithrombin complex (TAT), D-Dimer, plasminogen activator inhibitor 1 (PAI-1), antithrombin, fibrinogen, von Willebrand factor (VWF) antigen and high molecular weight VWF (HMW-VWF) multimers, P-selectin, tumor necrosis factor alpha (TNF-alpha), and interleukin 6 (IL-6). Plasma samples were collected at the following time points: at T0 (baseline) and T1 (+24 days of therapy), T2 (+36 days therapy), and T3 (+64 days therapy). The results show that, at diagnosis, ALL children presented with laboratory signs of increased thrombin generation and fibrin formation (i.e. high TAT and D-dimer levels), fibrinolysis inhibition (i.e. high PAI-1 level), endothelial activation (i.e., high HMW-VWF and soluble P-selectin levels) and inflammation (i.e. high TNF-alpha and IL-6 levels). After starting induction therapy, the thrombin generation markers and inflammatory cytokines significantly decreased. To the opposite, PAI-1 and P-selectin significantly increased, suggesting an insult by chemotherapy on the vascular endothelium. These effects were more evident during steroid administration. Symptomatic venous thromboembolism (VTE) episodes developed in two cases during induction therapy, which did not allow the evaluation of the predictive value for VTE of laboratory markers.
Databáze: OpenAIRE
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