Thrombin Generation Profile Using ST-Genesia after PEG-asparaginase in Pediatric Patients with Acute Lymphoblastic Leukemia
Por:
Ruiz-Llobet A, Gassiot S, Sarrate E, Zubicaray J, Rives-Solà S, Suleman W and Berrueco R
Publicada:
1 oct 2024
Ahead of Print:
1 may 2024
Resumen:
Background: Venous thromboembolism (VTE) etiology in children with acute lymphoblastic leukemia (ALL) is multifactorial. The use of global assays of hemostasis as a thrombin generation test (TGT) is useful to individualize VTE risk in adult patients. This prospective cohort study aimed to evaluate the usefulness of an automated TGT to evaluate VTE risk during ALL treatment in children. Methods: TGT (automated analyzer ST Genesia; ThromboScreen) and pro- and anticoagulant plasma proteins were analyzed during ALL treatment in pediatric patients following LAL-SEHOP-PETHEMA-2013 guidelines. Results were compared with a series of pediatric normal controls and evaluated according to pegylated asparaginase PEG-ASP administration and to VTE risk factors. Results: The study included 67 patients: males n = 35, B-ALL (n = 60). None had a VTE during the evaluated period. Compared to healthy controls, the normalized endogenous thrombin potential (N-ETP) ratio in patients was higher and ETP inhibition (ETP-inh) was lower, especially after PEG-ASP administration. Plasmatic protein C and protein S levels decreased after PEG-ASP administration, but antithrombin mean level did not. A bivariant analysis showed that ETP-inh was lower in patients >10 years old (p = 0.05) and in those with non-O blood type (p = 0.005). A linear mixed model also showed a higher TGT prothrombotic profile in patients with inherited thrombophilia. Conclusion: TGT could be a biomarker of a high VTE risk in ALL pediatric patients. Non-O blood group and inherited thrombophilia were associated with a significantly higher thrombotic profile, and an increased profile was also observed after administration of PEG-ASP.
Filiaciones:
Ruiz-Llobet A:
Servicio de Hematología Pediátrica, Sant Joan de Deu Hospital, Barcelona, Spain
Gassiot S:
Laboratory of Hematology, Sant Joan de Deu Hospital, Barcelona, Spain
Sarrate E:
Laboratorio de Hematología, Sant Joan de Deu Hospital, Barcelona, Spain
Zubicaray J:
Hematología, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
Rives-Solà S:
Unidad de leucemia y linfoma, Sant Joan de Deu Hospital, Barcelona, Spain
Suleman W:
Laboratorio de Hematología, Sant Joan de Deu Hospital, Barcelona, Spain
Berrueco R:
Servicio de Hematología Pediátrica, Sant Joan de Deu Hospital, Barcelona, Spain
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