Mattioli Belmonte M, Gugliotta L, Delvos U, Catani L, Vianelli N, Cascione M L, Belardinelli A R, Mottola L, Tura S
Istituto di Ematologia, L. e A. Seràgnoli, Università di Bologna, Italy.
Haematologica. 1991 May-Jun;76(3):209-14.
Seventeen adult patients with acute lymphoblastic leukemia (ALL) treated with L-asparaginase (20,000 IU/m2 on six alternate days) were infused with antithrombin III (AT III) concentrates (Kybernin P, Behring). Substitution therapy was aimed at increasing the reduced AT III concentration usually found in these patients, since AT III deficiency is thought to be associated with an increased risk of thrombosis. Two schedules of AT III administration, different in dosage, timing and duration were evaluated. The first 7 patients (group A) received a fixed dose of 2,000 U every day for 6 times, starting with the second L-asparaginase (L-ase) infusion, independently of their plasma AT III levels. In the following 10 patients (group B), 20-25 U/Kg b.w. were administered daily for 7 times only when the plasma AT III level was lower than 60% with plasma fibrinogen higher than 100 mg/dl and platelet count higher than 50 x 10(9)/l, or when AT III was below 40%. Thirteen patients who received L-ase without AT III substitution served as controls.
Both substitution regimens resulted in mean plasma AT III nadir values significantly (p less than 00.1) higher than in the controls. Our data suggest that, in ALL patients receiving L-ase according to the L20 protocol, satisfactory plasma AT III levels may be assured with infusions of 20-25 U/Kg b.w./day for 7-10 days, starting by day 2 of L-ase treatment.
17例接受L-天冬酰胺酶（20,000 IU/m²，隔日1次，共6次）治疗的成年急性淋巴细胞白血病（ALL）患者输注了抗凝血酶III（AT III）浓缩物（Kybernin P，贝林公司）。替代疗法旨在提高这些患者通常出现的降低的AT III浓度，因为AT III缺乏被认为与血栓形成风险增加有关。评估了两种AT III给药方案，在剂量、时间和持续时间上有所不同。前7例患者（A组）从第二次L-天冬酰胺酶（L-ase）输注开始，每天接受固定剂量2,000 U，共6次，与他们的血浆AT III水平无关。在随后的10例患者（B组）中，仅当血浆AT III水平低于60%、血浆纤维蛋白原高于100 mg/dl且血小板计数高于50×10⁹/l，或AT III低于40%时，每天给予20 - 25 U/kg体重，共7次。13例接受L-ase但未进行AT III替代的患者作为对照。
两种替代方案均导致血浆AT III最低值显著高于对照组（p<0.01）。我们的数据表明，在按照L20方案接受L-ase治疗的ALL患者中，从L-ase治疗第2天开始，每天输注20 - 25 U/kg体重，持续7 - 10天，可确保达到满意的血浆AT III水平。
