Coagulation abnormality as a complication of L-asparaginase therapy in childhood lymphoblastic leukemia

Abstract

Background Bleeding, one of the most common symptoms of acute leukemia in untreated patients, is mostly due to thrombocy- topenia as a result of myeloinvasion by leukemic cells. Neverthe- less, a further contributory factor for the additional hemorrhagic complication during intensive chemotherapy is the myelosuppressive effect of most active drugs. L-asparaginase, one of the cytostatics used during remission induction therapy for childhood of acute lymphoblastic leukemia (ALL), is widely reported to impair the he- mostatic system. Objective To determine the influence of shorter courses of L-as- paraginase (L-Ase) on some of the hemostatic parameters in the treatment of childhood ALL. Methods A prospective analytical study was carried out in the Department of Child Health, Cipto Mangunkusumo Hospital Jakarta from July 1, 1999 to June 30, 2001 on newly diagnosed ALL pa- tients with normal liver function tests treated according to our na- tional ALL protocol which one of its composition contained 6 in- stead of 9 injections of L-asparaginase. Results All of 30 children with ALL included in the study, experi- enced prolongation of prothrombin time (PT), activated partial thromboplastin time (aPTT), and decreased fibrinogen concentra- tion, markedly during the administration of L-asparaginase. How- ever, none of the patients had additional hemorrhage or evidence of disseminated intravascular coagulation (DIC). Conclusion The use of shorter courses of L-asparaginase, 6 in- jections, in the remission induction chemotherapy of childhood ALL in our department may reduce the blood clotting factors without further hemorrhage complication or evidence of DIC

Keywords

• L-asparaginase
• childhood ALL
• coagulation
• bleeding