L-asparaginase-induced coagulopathy in acute lymphoblastic leukemia

L-asparaginase is widely used in the treatment of acute lymphoblastic leukemia (ALL). It induces an inhibition of synthesis of many proteins, among them most of those involved in blood coagulation and fibrinolysis. The alterations of the hemostatic system are rather complex, consisting of a widespread depression of procoagulant factors as well as coagulation inhibitors or fibrinolytic factors. The degree of reduction in these proteins seems to some extent dependent on the L-asparaginase dosage, even though definitive conclusions are difficult to reach because of heterogeneity in the treatment schedules applied in the different studies. However the final balance of hemostatic alterations seems to be shifted towards a prothrombotic state, as suggested by the detection of an increase in some markers of in vivoblood coagulation activation. This supports the clinical evidence of an increased prevalence of severe thrombotic complications in patients receiving L-asparaginase. © 1992 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.