الفهرس 
Childhood Acute Lymphoblastic LeukaemiaOnly 14 pages are availabe for public view
 |  | from | 238 |  |  |
| | | from | 238 | | |
Abstract
Background: Thromboembolism (TE) is a well-recognized serious complication in
association with ALL leading to significant morbidity. Development of TE does
interfere with the scheduled treatment plan for ALL and, thus, ultimate outcome from
ALL. Concomitant administration of asparaginase and steroids is likely to be
associated with higher incidence of TE, especially in children with at least one
prothrombotic risk factor.
Aim: To study the incidence and outcome of asparaginase related coagulopathy and
to assess biological, laboratory and clinical parameters affecting thromboembolic risk.
Methods: A retrospective study of 416 pediatric ALL patients who were treated at the
Children’s Cancer Hospital in Egypt (CCHE) during the time period between 7th of
July 2007 and end of July 2009 and followed till end of may 2010. They received
ALL protocol adopted from SJCRH study XV for low and standard/high risk.
Results: Twenty patients (4.8%) had coagulopathy related to L-asparaginase. CNS
affection occurred in 12 patients (60%), DVT in neck and lower limbs in 8 patients
(40%). The Majority of patients had thrombosis (55%), followed by cerebral
haemorrhage (20%), cerebral thrombosis combined with haemorrhagic infarction
(15%), cerebral Ischemia (5%) and cerebral infarction (5%). Seven patients (35%)
occurred during induction, 3 (15%) post induction and 10 (50%) during maintenance.
Four cases died as a complication to L-ASP induced coagulopathy events, all of them
had CNS affection.
The total dosage of L-ASP and Dexamethazone were significantly higher in SR/HR
than LR protocol. It was found that age, and risk stratification significantly increased
the risk of L-ASP coagulopathy and only age retained its significance on multivariate
analysis. Event free and overall survival were adversely affected in L-ASP positive
patients, while disease free survival was not. Risk stratification and L-ASP
coagulopathies were the only factors that independently affected event free survival
and overall survival.
Conclusion: It can be concluded that combination of L-ASP and steroids increased
the risk of coagulopathy in ALL pediatric patients especially in older ages, higher risk
and higher doses of L-ASP. Mortality related to TE events affected outcome of
patients.
Keywords: Acute lymphoblastic leukemia, Asparaginase, Thromboembolism,
Haemorrhage.