Miniero R, Pastore G, Saracco P, Messina M, Lange M M, Fiandino G, Iannacci L, Madon E
Am J Pediatr Hematol Oncol. 1986 Summer;8(2):116-20.
Hemostatic changes in 20 children with acute lymphoblastic leukemia (ALL) who were induced with L-asparaginase (L-asp), vincristine (VCR), and prednisone (PDN) (Group A) were prospectively evaluated. These data were compared with those of a previous group of ALL patients who received L-asp as a single agent during consolidation (Group B). In Group A patients, mean plasma antithrombin activity decreased in the first 2 weeks, though not significantly. Relative to pretreatment values, mean fibrinogen concentration diminished particularly by week 3 (p less than 0.001). Activated partial thromboplastin time (APTT) decreased in the last week as well as after cessation of therapy with L-asp (p less than 0.05). Mean platelet count increased significantly by week 3 (p less than 0.05). Thromboelastograms performed in seven patients confirmed the tendency for thrombosis evidenced by a decreased APTT. Patients in Group B (L-asp alone during consolidation) had decreased concentrations of fibrinogen, AT, and Factors IX and X after L-asp therapy. APTT was prolonged. Our data demonstrate that the tendency for thrombosis is the predominant manifestation of L-asp induced coagulopathy, when the drug is associated with VCR and PDN. Thus the risk/benefit ratio for the use of L-asp early in induction in children with low risk ALL needs to be further evaluated.
对20例接受L-天冬酰胺酶（L-asp）、长春新碱（VCR）和泼尼松（PDN）诱导治疗的急性淋巴细胞白血病（ALL）患儿的止血变化进行了前瞻性评估（A组）。将这些数据与之前一组在巩固治疗期间接受L-asp单药治疗的ALL患者的数据进行比较（B组）。在A组患者中，平均血浆抗凝血酶活性在最初2周有所下降，尽管不显著。相对于治疗前值，平均纤维蛋白原浓度在第3周时尤其降低（p<0.001）。活化部分凝血活酶时间（APTT）在最后一周以及停止使用L-asp治疗后下降（p<0.05）。平均血小板计数在第3周时显著增加（p<0.05）。对7例患者进行的血栓弹力图检查证实了APTT降低所显示的血栓形成倾向。B组患者（巩固治疗期间仅使用L-asp）在接受L-asp治疗后，纤维蛋白原、抗凝血酶以及IX和X因子的浓度降低。APTT延长。我们的数据表明，当L-asp与VCR和PDN联合使用时，血栓形成倾向是L-asp诱导的凝血病的主要表现。因此，在低危ALL患儿诱导治疗早期使用L-asp的风险/获益比需要进一步评估。
