Abstract
Background: L- Asparaginase is commonly used chemotherapeutic agent in the treatment of acute lymphoblastic leukemia patients. The overall incidence of symptomatic venous thrombosis in acute lymphoblastic leukemia (ALL) varies from 1.5-11%. The risk of thrombotic complications in acute lymphoblastic leukemia (ALL) in children ranges from 1 to 37%. Most of the patients develop thrombosis related to L-asparaginase in the induction phase of chemotherapy.
Purpose: To highlight the incidence of life threatening thrombotic complications related to L –Asparginase in acute lymphoblastic leukemia patients.
Materials and Methods: This study was carried out retrospectively over a period of ten years. The data was taken from regional cancer registry and was compiled.
Conclusions: Early identification and management of life threatening thrombotic complications associated with L-asparaginaseis necessary to improve survival outcome in Acute lymphoblastic leukemia patients.
Keywords: Thrombosis, Acute lymphoblastic leukemia, L-Asparaginase.
References
- Capizzi RL, Bertino JR, Skeel RT, et al. l-asparaginase: clinical, biochemical, pharmacological, and immunological studies. Ann Intern Med. 1971;74:893–901.
- Horowitz B, Madras BK, Meister A, Old LJ, Boyes EA, Stockert E. Asparagine synthetase activity of mouse leukemias. Science. 1968;160:533–535.
- Haskell CM, Canellos GP. l-asparaginase resistance in human leukemia–asparagine synthetase. Biochem Pharmacol. 1969;18: 2578–2580.
- Kiriyama Y, Kubota M, Takimoto T, et al. Biochemical characterization of U937 cells resistant to l-asparaginase: the role of asparagine synthetase. Leukemia. 1989;3:294–297.
- Aslanian AM, Fletcher BS, Kilberg MS. Asparagine synthetase expression alone is sufficient to induce l-asparaginase resistance in MOLT-4 human leukaemia cells. Biochem J. 2001;357:321–328.
- Hutson RG, Kitoh T, Moraga Amador DA, Cosic S, Schuster SM, Kilberg MS. Amino acid control of asparagine synthetase: relation to asparaginase resistance in human leukemia cells. Am J Physiol. 1997;272:C1691–C1699.
- Asselin BL, Ryan D, Frantz CN, et al. In vitro and in vivo killing of acute lymphoblastic leukemia cells by l-asparaginase. Cancer Res. 1989;49:4363–4368.
- Grigoryan RS, Panosyan EH, Seibel NL, Gaynon PS, Avramis IA, Avramis VI. Changes of amino acid serum levels in pediatric patients with higher-risk acute lymphoblastic leukemia (CCG-1961) In Vivo. 2004;18(2):107–112.
- Boos J, Werber G, Ahlke E, et al. Monitoring of asparaginase activity and asparagine levels in children on different asparaginase preparations. Eur J Cancer. 1996;32A(9):1544–1550.
- Avramis VI, Sencer S, Periclou AP, et al. A randomized comparison of native Escherichia coli asparaginase and polyethylene glycol conjugated asparaginase for treatment of children with newly diagnosed standard-risk acute lymphoblastic leukemia: a Children’s Cancer Group study. Blood. 2002;99(6):1986–1994.
- Truelove E, Fielding AK, Hunt BJ. The coagulopathy and thrombotic risk associated with L-asparaginase treatment inadults with acute lymphoblastic leukaemia. Leukemia. 2013; 27(3):553-559.
- Athale UH, Chan AK. Thromboembolic complications in pediatric hematologic malignancies. Semin ThrombHemost. 2007;33:416– 26.
- Vázquez E, Lucaya J, Castellote A, Piqueras J, Sainz P, Olivé T, et al. Neuroimaging in pediatric leukemia and lymphoma: Differential diagnosis. Radiographics 2002;22:1411-28.
- Connor SE, Jarosz JM. Magnetic resonance imaging of cerebral venous sinus thrombosis. ClinRadiol 2002;57:449-61.
- Grace RF, Dahlberg SE, Neuberg D, et al. The frequency and management of asparaginase-related thrombosis in paediatric and adult patients with acute lymphoblastic leukaemia treated on Dana-Farber Cancer Institute consortium protocols.Br J Haema-tol. 2011;152 (4):452-459.
- Payne JH, Vora AJ. Thrombosis and acute lymphoblastic leukae-mia.Br J Haematol. 2007;138(4):430-445.treatment inadults with acute lymphoblastic leukaemia. Leukemia.2013;27(3):553-559.
- Payne JH, Vora AJ. Thrombosis and acute lymphoblastic leukae-mia.Br J Haematol. 2007;138(4):430-445.
- Truelove E, Fielding AK, Hunt BJ. The coagulopathy and thrombotic risk associated with L-asparaginase
- H. Payne and A. J. Vora, “Thrombosis and acute lymphoblastic leukaemia,” British Journal of Haematology, vol. 138, no. 4, pp. 430–445, 2007.
- Mitchell LG, Andrew M, Hanna K, et al. A prospective cohort study determining the prevalence of thrombotic events in children with acute lymphoblastic leukemia and a central venous line who are treated with l-asparaginase: results of the prophylactic antithrombin replacement in kids treated with acute lymphoblastic leukemia treated with aspara-ginase (PARKAA) study. 2003;97:508–516
- Truelove E, Fielding AK, Hunt BJ. The coagulopathy and thrombotic risk associated with L-asparaginase treatment in adults with acute lymphoblastic leukaemia. Leukemia. 2013;27(3):553–559
- Payne JH, Vora AJ. Thrombosis and acute lymphoblastic leukaemia. J. Haematol. 2007;138(4):430–445.
- Grace RF, Dahlberg SE, Neuberg D, et al. The frequency and management of asparaginase-related thrombosis in paediatric and adult patients with acute lymphoblastic leukaemia treated on Dana-Farber Cancer Institute consortium protocols. Br. J. Haematol. 2011;152(4):452–459.
Corresponding Author
Nusrat Bashir
Government Medical College Srinagar, Jammu and Kashmir INDIA
Email: This email address is being protected from spambots. You need JavaScript enabled to view it., 9419029270
DOI: https://dx.doi.org/10.18535/jmscr/v6i4.34
