Supportive care for hemostatic complications associated with pediatric leukemia: a national survey in Japan
Supportive care for hemostatic complications associated with pediatric leukemia: a national survey in Japan
复制标题
DOI：
10.1007/s12185-019-02740-9
复制
发表时间：
2019-12-01
影响因子：
2.1
通讯作者：
Adachi, Souichi
中科院分区：
文献类型：
--
作者：
Osone, Shinya;Fukushima, Keitaro;Adachi, Souichi
针对弥散性血管内凝血 (DIC) 和天冬酰胺酶止血并发症的最佳支持治疗对于成功治疗儿童白血病至关重要。然而，日本有关此类护理的情况尚不清楚。我们对日本 155 家治疗儿童白血病的机构进行了问卷调查。调查问卷询问了各机构为患有 DIC 和天冬酰胺酶引起的止血改变的急性白血病患者提供的支持护理。九十八家机构作出回应。 DIC 最常见的诊断标准是由日本厚生省制定的标准。无论 DIC 的病因是什么，大约 70% 和 40% 的机构分别使用重组人血栓调节蛋白和合成蛋白酶抑制剂作为抗凝治疗。此外，92%、93%和73%的机构在急性淋巴细胞白血病诱导治疗期间分别每周两次以上测量血浆抗凝血酶、纤维蛋白原和D-二聚体/纤维蛋白降解产物。调查回复表明，95% 和 24% 的机构分别使用抗凝血酶替代品和新鲜冰冻血浆。日本儿科中心对 DIC 和/或天冬酰胺酶引起的止血改变的支持治疗非常密集，与其他国家的方案明显不同。应在儿童白血病的情况下前瞻性评估支持治疗的疗效。
Optimal supportive care for disseminated intravascular coagulation (DIC) and hemostatic complications by asparaginase is indispensable for the successful treatment of pediatric leukemia. However, the situation regarding this type of care in Japan is unclear. We conducted a questionnaire-based survey at 155 institutions treating childhood leukemia in Japan. The questionnaire asked about the supportive care provided by each institution to acute leukemia patients with DIC and asparaginase-induced hemostatic alterations. Ninety-eight institutions responded. The most common diagnostic criteria for DIC were those established by the Japanese Ministry of Health and Welfare. Regardless of the etiology underlying DIC, recombinant human thrombomodulin and synthetic protease inhibitors were used as anticoagulation therapy by around 70% and 40% of institutions, respectively. Additionally, 92%, 93%, and 73% of institutions measured plasma antithrombin, fibrinogen, and D-dimer/fibrin degradation products, respectively, more than twice per week during induction therapy for acute lymphoblastic leukemia. Survey responses indicate that 95% and 24% of the institutions used antithrombin replacement and fresh-frozen plasma, respectively. Supportive care for DIC and/or asparaginase-induced hemostatic alterations at Japanese pediatric centers was intensive and differs markedly from protocols in other countries. The efficacy of supportive care should be evaluated prospectively in the setting of pediatric leukemia.