Minimal effects ofE. coli and Erwinia asparaginase on the coagulation system in childhood acute lymphoblastic leukemia: A randomized study
| Autor: | Inge M. Risseeuw-Appel, Wim C. J. Hop, Ina Dekker, Karel Hählen |
|---|---|
| Rok vydání: | 1994 |
| Předmět: |
Male
Cancer Research medicine.medical_specialty Vincristine Asparaginase medicine.medical_treatment Erwinia Gastroenterology chemistry.chemical_compound Prednisone Internal medicine Acute lymphocytic leukemia Escherichia coli medicine Humans Child Blood Coagulation Chemotherapy medicine.diagnostic_test biology business.industry Fibrinogen Precursor Cell Lymphoblastic Leukemia-Lymphoma biology.organism_classification medicine.disease Blood Coagulation Factors Oncology chemistry Child Preschool Pediatrics Perinatology and Child Health Immunology Female Partial Thromboplastin Time business Protein C medicine.drug Partial thromboplastin time |
| Zdroj: | Medical and Pediatric Oncology. 23:335-343 |
| ISSN: | 1096-911X 0098-1532 |
| Popis: | A randomized study was done in twenty newly diagnosed children with acute lymphoblastic leukemia. Ten children were treated with Escherichia coli L-asparaginase, and ten with Erwinia chrysanthemi L-asparaginase. L-asparaginase (ASP) treatment started halfway during ALL-induction treatment with vincristine, prednisone, daunorubicin and intrathecal methotrexate. The mean activated partial thromboplastin time (APTT) level in all children demonstrated a significant fall (P < 0.001) from 28.25 sec at diagnosis to 23.0 sec at the start of ASP treatment. In this same time interval, the mean fibrinogen level declined markedly from 3 g/l to 1.2 g/l (P < 0.001), probably due to prednisone therapy. The APTT stayed shortened during ASP therapy, whereas the hypofibrinogenemia recovered significantly faster in the Erwinia group (P < or = 0.01). Factors (F) II, V, VII and X stayed within the normal range, while F VIII and F IX were elevated. During the entire period of induction therapy, the ATIII activity remained within the normal range in both treatment groups. The protein C values, however, demonstrated a steady decline from 140% at start of ASP treatment to a mean of 81% and 93%, respectively, at the end of the ASP therapy in the E. coli and Erwinia group. Five of the ten children treated with E. coli ASP demonstrated protein C levels below 70% at the end of ASP therapy, opposed to none of the Erwinia treated patients (P = 0.03). We suggest that the effect of ASP resulting in decreased coagulation factor synthesis is in part counterbalanced by the effect of prednisone on the coagulation system, when ASP is administered at the end of ALL induction treatment. The overall effect of ASP either of E. coli or of Erwinia on the hemorrhagic system reveals a slight imbalance towards thrombosis, mainly because of a gradual decrease in protein C activity. This imbalance is less pronounced in the Erwinia group. |
| Databáze: | OpenAIRE |
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