Inhibitors in Childhood Acute Lymphoblastic Leukemia

Abstract

The effects of high-dose methotrexate (HDMTX) treatment the coagulation inhibitors have not previously investigated. Protein C, protein S, antithrombin III, fibrinogen, fibrin degradation products, prothrombin time (PT), activated partial thrombin time (APTT) and tissue plasminogen activator (t-PA) levels were measured in 36 courses of HDMTX and folinic acid rescue treatment of 20 childhood acute lymphoblastic leukemia patients at baseline, and on days 1 and 7. After the treatment, all levels excluding t-PA were lower on day I than baseline and the difference was significant. PT and PTT were elongated. The levels returned to baseline values on day 7, excluding fibrin degradation products. Fibrinogen and t-PA levels were unchanged with therapy. After treatment courses neutropenia (23.3%), gastrointestinal intolerance (16.6%) and mucositis (11%) were observed. Protein C, protein S and antithrombin ill levels decrease and PT and PTT elongate in patients with HDMTX treatment, but these transient changes do not cause clinical thromboembolic or hematological complications.