Department of Paediatric Oncology/Hematology, CHU de Reims, Reims, France.
EA3801-HERVI, Université de Reims Champagne-Ardenne, Reims, France.
J Thromb Thrombolysis. 2021 Apr;51(3):711-719. doi: 10.1007/s11239-020-02346-7. Epub 2020 Nov 28.
In paediatric acute lymphoblastic leukaemia (ALL), focus has shifted towards preventing treatment-related complications, including venous thromboembolism, the cause of significant mortality and morbidity. To better understand thrombogenic mechanisms during induction treatment, we studied the number, origin and procoagulant activity of extracellular vesicles (EVs) and P-selectin level throughout the induction course in 24 paediatric patients. EVs were mainly of platelet origin. We observed a significant increase in EV number, in platelet EV number and P-selectin level throughout the induction course. There was a correlation between higher EV and platelet EV number, P-selectin level, higher platelet count and leucocyte count. We also observed a correlation between higher EV procoagulant activity and higher platelet count and leucocyte count and higher P-selectin level. Older age and T phenotype were associated with a higher EV procoagulant activity. Platelet EV generation may play a role in thrombogenic complications in ALL patients and could serve as a biomarker to identify patients with a high risk of thrombosis. As a marker of platelet activation, P-selectin may be another relevant marker with the advantage of being easier to analyse in clinical practice.
在儿科急性淋巴细胞白血病 (ALL) 中，重点已转向预防治疗相关并发症，包括静脉血栓栓塞症，这是导致高死亡率和高发病率的原因。为了更好地了解诱导治疗期间的血栓形成机制，我们研究了 24 名儿科患者诱导治疗过程中细胞外囊泡 (EVs) 的数量、来源和促凝活性以及 P-选择素水平。EVs 主要来源于血小板。我们观察到 EV 数量、血小板 EV 数量和 P-选择素水平在整个诱导过程中显著增加。EV 数量和血小板 EV 数量、P-选择素水平、血小板计数和白细胞计数较高之间存在相关性。我们还观察到 EV 促凝活性与血小板计数和白细胞计数较高以及 P-选择素水平较高之间存在相关性。年龄较大和 T 表型与 EV 促凝活性较高有关。血小板 EV 的产生可能在 ALL 患者的血栓形成并发症中起作用，并可作为一种生物标志物，以识别具有高血栓形成风险的患者。作为血小板活化的标志物，P-选择素可能是另一个相关的标志物，其优势在于在临床实践中更容易分析。
