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Prepublished online as a Blood First Edition Paper on November 27, 2002; DOI 10.1182/blood-2002-06-1901. This Article Full Text (PDF) All Versions of this Article: 2002-06-1901v1 101/7/2529    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Nowak-Gottl, U. Articles by Junker, R. Search for Related Content PubMed PubMed Citation Articles by Nowak-Gottl, U. Articles by Junker, R. Social Bookmarking                   What's this? Submitted June 27, 2002 Accepted November 19, 2002 Thromboembolic events in children with acute lymphoblastic leukemia (BFM protocols): prednisone versus dexamethasone administration Ulrike Nowak-Gottl*, Elvira Ahlke, Gudrun Fleischhack, Dirk Schwabe, Rosemarie Schobess, Christiane Schumann, and Ralf Junker Paediatric Haematology/Oncology, University Hospital, Muenster, Germany Paediatric Haematology/Oncology, University Hospital, Bonn, Germany Paediatric Haematology/Oncology, University Hospital, Frankfurt, Germany Childrens Hospital, University Hospital, Halle, Germany Institute of Clinical Chemistry and Laboratory Medicine/Institute of Ateriosclerosis Research, University Hospital, Muenster, Germany * Corresponding author; email: leagottl{at}uni-muenster.de. Alterations in hemostasis leading to symptomatic thromboembolism have been observed in patients with acute lymphoblastic leukemia (ALL) receiving E. coli asparaginase (CASP) combined with steroids. Moreover, hereditary prothrombotic risk factors are associated with an increased risk of venous thromboembolism in pediatric ALL patients treated according to the BFM 90/95 protocols (including CASP combined with prednisone during induction therapy). To assess whether the thromboembolic risk associated with established prothrombotic risk factors is modified by treatment modalities (prednisone or dexamethasone), the present analysis was performed. 336 consecutively recruited leukemic children treated according to different BFM protocols (PRED group, n=280, prednisone 60 mg/m2; DEXA group, n=56, 10 mg/m2 during induction therapy) were studied. Study endpoint was the onset of symptomatic vascular accidents during induction therapy. The cumulative thromboembolism-free survival was significantly reduced in children within the PRED group (thrombosis frequency: 10.4%) compared with children in the DEXA group (1.8%; p=0.028). Although no significant difference was found in the overall prevalence of prothrombotic risk factors, in the PRED group, 46.5% of the patients suffering a thromboembolic event were carriers of a prothrombotic risk factor, whereas in the DEXA group, no carrier suffered a thromboembolism. At the time of maximum CASP activity, fibrinogen concentrations as well as activities of antithrombin, plasminogen, and protein S were significantly reduced in the PRED group. No significant correlation could be found between CASP activity and levels of coagulation factors. In conclusion, the use of dexamethasone instead of prednisone, administered with CASP, significantly reduces the onset of venous thromboembolism. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: M. L. te Winkel, I. M. Appel, R. Pieters, and M. M. van den Heuvel-Eibrink Impaired dexamethasone-related increase of anticoagulants is associated with the development of osteonecrosis in childhood acute lymphoblastic leukemia Haematologica, October 1, 2008; 93(10): 1570 - 1574. [Abstract] [Full Text] [PDF] J. M. Rowe and A. H. Goldstone How I treat acute lymphocytic leukemia in adults Blood, October 1, 2007; 110(7): 2268 - 2275. [Abstract] [Full Text] [PDF] I. Paz-Priel, L. Long, L. J. Helman, C. L. Mackall, and A. S. Wayne Thromboembolic Events in Children and Young Adults With Pediatric Sarcoma J. Clin. Oncol., April 20, 2007; 25(12): 1519 - 1524. [Abstract] [Full Text] [PDF] V. Caruso, L. Iacoviello, A. Di Castelnuovo, S. Storti, G. Mariani, G. de Gaetano, and M. B. Donati Thrombotic complications in childhood acute lymphoblastic leukemia: a meta-analysis of 17 prospective studies comprising 1752 pediatric patients Blood, October 1, 2006; 108(7): 2216 - 2222. [Abstract] [Full Text] [PDF] D. Hernandez-Espinosa, A. Minano, C. Martinez, E. Perez-Ceballos, I. Heras, J. L. Fuster, V. Vicente, and J. Corral L-Asparaginase-Induced Antithrombin Type I Deficiency: Implications for Conformational Diseases Am. J. Pathol., July 1, 2006; 169(1): 142 - 153. [Abstract] [Full Text] [PDF]

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