Cerebral infarction in childhood acute lymphoblastic leukaemia treated with low dose E. coli Asparaginase

Abstract

The occurrence of thrombosis complicating L-asparaginase therapy in childhood acute lymphoblastic leukaemia has been supported by both laboratory and clinical evidences, but the exact pathogenic mechanism and predisposing factors remain elusive. Two children with acute lymphoblastic leukaemia (ALL) treated with chemotherapy developed cerebral infarction during the third week of induction therapy which consists of relatively low dose E. coli asparaginase (6,000 iu/m 2/dose three times weekly). Altered hemostatic profile was observed in both patients during the attack but they were likely to be induced by the asparaginase treatment as shown by the return of normal profile in the post-chemotherapy period for the survived patient. There were inconsistent observations on the role of pre-existing prothrombotic conditions in previous studies and our findings further suggest that the cause is likely to be multifactorial. More investigations are needed to clarify if co-existing prothrombotic defects, either inherited or acquired, play a significant role in the causation of thrombosis in local childhood ALL patients receiving asparaginase therapy.