Title: L-Asparaginase Related Thrombotic Complications in Acute Lymphoblastic Leukemia Patients – An Experience from a Tertiary Care Centre

Authors: Yasir Bashir, Nusrat Bashir, Tazeen Jeelani, Dekyong Angmo, Sajad Jeelani, Javid Rasool

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i4.34

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

  1. Capizzi RL, Bertino JR, Skeel RT, et al. l-asparaginase: clinical, biochemical, pharmacological, and immunological studies. Ann Intern Med. 1971;74:893–901.
  2. Horowitz B, Madras BK, Meister A, Old LJ, Boyes EA, Stockert E. Asparagine synthetase activity of mouse leukemias. Science. 1968;160:533–535.
  3. Haskell CM, Canellos GP. l-asparaginase resistance in human leukemia–asparagine synthetase. Biochem Pharmacol. 1969;18: 2578–2580.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. Athale UH, Chan AK. Thromboembolic complications in pediatric hematologic malignancies. Semin ThrombHemost. 2007;33:416– 26.
  13. 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.
  14. Connor SE, Jarosz JM. Magnetic resonance imaging of cerebral venous sinus thrombosis. ClinRadiol 2002;57:449-61.
  15. 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.
  16. 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.
  17. Payne JH, Vora AJ. Thrombosis and acute lymphoblastic leukae-mia.Br J Haematol. 2007;138(4):430-445.
  18. Truelove E, Fielding AK, Hunt BJ. The coagulopathy and thrombotic risk associated with L-asparaginase
  19. H. Payne and A. J. Vora, “Thrombosis and acute lymphoblastic leukaemia,” British Journal of Haematology, vol. 138, no. 4, pp. 430–445, 2007.
  20. 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
  21. 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
  22. Payne JH, Vora AJ. Thrombosis and acute lymphoblastic leukaemia. J. Haematol. 2007;138(4):430–445.
  23. 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

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