1The Pediatric Hematology Unit of the Department of Pediatrics, Medical School of Gazi University, Ankara, Turkey.
Clin Appl Thromb Hemost. 2013 Nov-Dec;19(6):644-51. doi: 10.1177/1076029612450771. Epub 2012 Jun 29.
Induction chemotherapy is associated with increased thrombosis risk in children with acute lymphoblastic leukemia (ALL). In this prospective study, we explored the effects of ALL and induction chemotherapy on the procoagulant, anticoagulant, and fibrinolytic systems in 20 children with ALL. The levels of d-dimer, factor VIII, von Willebrand factor, protein C, antithrombin III, and thrombin-activated fibrinolysis inhibitor (TAFI) were elevated at diagnosis. These changes were not related with peripheral blast count. The levels of fibrinogen, d-dimer, coagulation inhibitors, and plasminogen decreased, whereas the levels of tissue factor pathway inhibitor and plasminogen activator inhibitor 1 increased progressively following prednisolone monotherapy, administration of vincristine plus daunorubicin, and l-asparaginase. The levels of factor VIII, d-dimer, and TAFI remained elevated during the study period. In conclusion, coagulation activation and impaired fibrinolysis already exist at diagnosis, whereas induction chemotherapy leads to reactivation of coagulation and progressive impairment in fibrinolytic and anticoagulant capacities in childhood ALL.
诱导化疗与儿童急性淋巴细胞白血病（ALL）的血栓形成风险增加有关。在这项前瞻性研究中，我们探讨了 ALL 和诱导化疗对 20 例 ALL 患儿促凝、抗凝和纤溶系统的影响。在诊断时，d-二聚体、VIII 因子、血管性血友病因子、蛋白 C、抗凝血酶 III 和凝血酶激活的纤溶抑制物（TAFI）水平升高。这些变化与外周血 blast 计数无关。纤维蛋白原、d-二聚体、凝血抑制剂和纤溶酶原水平逐渐下降，而组织因子途径抑制剂和纤溶酶原激活物抑制剂 1 水平在泼尼松单药治疗、长春新碱加柔红霉素和 L-天冬酰胺酶给药后逐渐升高。VIII 因子、d-二聚体和 TAFI 水平在研究期间仍然升高。总之，在诊断时已经存在凝血激活和纤溶受损，而诱导化疗导致儿童 ALL 中凝血的重新激活和纤溶及抗凝能力的逐渐受损。
