Thromboembolism in adults with acute lymphoblastic leukemia during induction with L-asparaginase-containing multi-agent regimens: Incidence, risk factors, and possible role of antithrombin
Thromboembolism in adults with acute lymphoblastic leukemia during induction with L-asparaginase-containing multi-agent regimens: Incidence, risk factors, and possible role of antithrombin
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DOI：
10.1080/10428190410001693588
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发表时间：
2004-08-01
影响因子：
2.6
通讯作者：
Litzow, MR
中科院分区：
文献类型：
--
作者：
Elliott, MA;Wolf, RC;Litzow, MR
血栓栓塞（TE）是L -天冬酰胺酶（ASP）治疗急性淋巴细胞白血病（ALL）的已知并发症，可能归因于天然抗凝剂（特别是抗凝血酶（AT））的合成减少。本回顾性单机构研究旨在确定接受含ASP的当代方案诱导的成人TE发生率。在首次ASP给药后中位5.5天，54名连续成人中有10名（18.5%）出现症状性、客观证实的TE。这些在CNS和上肢定位方面值得注意，根据ALL免疫表型（前体B：11% vs. T细胞：33%）显著变化，ASP的给药方案或总剂量无明显影响。平均基线AT水平为94%，ASP治疗期间降至最低点47%（P < 0.0001）。17例在ASP治疗期间预防性AT。这些患者均未发生TE，而10/37例（27%）未进行置换（P = 0.021）。这些观察结果值得进一步研究，以深入了解该人群中TE的疾病和/或治疗特异性发病机制，并呼吁对适当的预防性干预措施进行前瞻性评价。
Thromboembolism (TE) is a known complication of L -asparaginase (ASP) therapy of acute lymphoblastic leukemia (ALL), possibly attributable to reduced synthesis of natural anticoagulants, in particular antithrombin (AT). This retrospective single institution study was performed to determine the TE incidence among adults undergoing induction with contemporary, ASP-containing regimens. Ten of 54 (18.5%) consecutive adults developed symptomatic, objectively confirmed TE, at a median of 5.5 days after the first ASP dose. These were notable for CNS and upper extremity localization, varied significantly according to ALL immunophenotype (precursor B: 11% vs. T cell: 33%), without apparent effect of schedule or total dose of ASP. Median baseline AT level was 94% and fell to a nadir of 47% ( P < 0.0001) during ASP therapy. Prophylactic AT had been given to 17 during ASP therapy. None of these developed TE vs. 10/37 (27%) without replacement ( P = 0.021). These observations merit further study to gain insight into disease and/or therapy-specific pathogenesis of TE in this population and call for the prospective evaluation of appropriate prophylactic interventions.