Inherited and acquired thrombophilia are associated with venous thromboembolic events (TE). The prevalence of inherited and acquired prothrombotic risk factors and the incidence of symptomatic TE were evaluated in a cohort of 114 adult acute leukemia patients. The most frequent prothrombotic risk factor was hyperhomocysteinemia which occurred in 46.6% of patients. The incidence of TE was 9.6%, mainly in the first month of follow-up. In multivariate analysis, hyperhomocysteinemia was the only risk factor for TE (OR 33.90; 95% CI 1.53–751.33; p = 0.026). The results of this study indicate that measurements of homocysteinemia could be useful in determining the risk of early TE in adult acute leukemia patients, while systematic thrombophilia screening should not be justified.

Keywords:
Adult acute leukemia, Thromboembolic events, Thrombophilia
1.
Leone G, Sica S, Chiusolo P, Teofili L, De Stefano V: Blood cell diseases and thrombosis. Haematologica 2001;86:1236–1244.
2.
Cortellezzi A, Moia M, Falanga A, Pogliani EM, Agnelli G, Bonizzoni E, Gussoni G, Barbui T, Mannucci PM, on behalf of the CATHEM Study Group: Incidence of thrombotic complications in patients with haematological malignancies with central venous catheters: a prospective multicentre study. Br J Haematol 2005;129:811–817.
3.
Nowak-Gottl U, Wermes C, Junker R, Koch HG, Schobess R, Fleischhack G, Schwabe D, Ehrenforth S: Prospective evaluation of the thrombotic risk in children with acute lymphoblastic leukemia carrying the MTHFR TT677 genotype, the prothrombin G20210A variant and further prothrombotic risk factors. Blood 1999;93:1595–1599.
4.
De Stefano V, Sorà F, Rossi E, Chiusolo P, Laurenti L, Fianchi L, Zini G, Pagano L, Sica S, Leone G: The risk of thrombosis in patients with acute leukemia: occurrence of thrombosis at diagnosis and during treatment. J Thromb Haemost 2005;3:1985–1992.
5.
Ziegler S, Wolfgang RS, Knobl P, Lehr S, Weltermann A, Jager U, Valent P, Lechner K: Symptomatic venous thromboembolism in acute leukemia: incidence, risk factors and impact on prognosis. Thromb Res 2005;115:59–64.
6.
Lo Coco F, Nervi C, Avvisati G, Mandelli F: Acute promyelocytic leukemia: a curable disease. Leukemia 1998;12:1866–1880.
7.
Exner T, Triplett DA, Taberner D, Machin SJ: Guidelines for testing and revised criteria for lupus anticoagulants. SSC Subcommittee for the Standardization of Lupus Anticoagulants. Thromb Haemost 1991;65:320–322.
8.
Magera MJ, Lacey JM, Casetta B, Rinaldo P: Method for the determination of total homocysteine in plasma and urine by stable isotope dilution and electrospray tandem mass spectrometry. Clin Chem 1999;45:1517–1522.
9.
Grandone E, Margaglione M, Colaizzo D, d’Addedda M, Cappucci G, Vecchione G, Sciannamè N, Pavone G, Di Minno G: Factor V Leiden is associated with repeated and recurrent fetal losses. Thromb Haemost 1997;77:822–824.
10.
Margaglione M, Brancaccio V, Giuliani N, D’Andrea G, Cappucci G, Iannaccone L, Vecchione G, Grandone E, Di Minno G: Increased risk for venous thrombosis in carriers of the prothrombin G→A 20210 gene variant. Ann Intern Med 1998;129:89–93.
11.
Grandone E, Margaglione M, Colaizzo D, D’Andrea G, Cappucci G, Brancaccio V, Di Minno G: Genetic susceptibility to pregnancy-related venous thromboembolism: role of factor V Leiden, prothrombin G20210A and C677T methylenetetrahydrofolate reductase mutations. Am J Obstet Gynecol 1998;179:1324–1328.
12.
Carlsson H, Stockelberg D, Tengborn L, Braide I, Carneskog J, Kutti J: Effects of Erwinia-asparaginase on the coagulation system. Eur J Haematol 1995;55:289.
13.
Falanga A, Barbui T: Coagulopathy of acute promyelocytic leukemia. Acta Haematol 2001;106:43–51.
14.
Rodeghiero F, Mannucci PM, Vigano S, Barbui T, Gugliotta L, Cortellaro M, Dini E: Liver dysfunction rather than intravascular coagulation as the main cause of low protein C and antithrombin III in acute leukemia. Blood 1984;63:965–969.
15.
Lossos IS, Bogomolski-Yahalom V, Matzner Y: Anticardiolipin antibodies in acute myeloid leukemia: prevalence and clinical significance. Am J Hematol 1998;57:139–143.
16.
Galli M, Luciani D, Bertolini G, Barbui T: Lupus anticoagulants are stronger risk factors for thrombosis than anticardiolipin antibodies in the antiphospholipid syndrome: a systematic review of the literature. Blood 2003;101:1827–1832.
17.
De Stefano V, Casorelli I, Rossi E, Zappacosta B, Leone G: Interaction between hyperhomocysteinemia and inherited thrombophilic factors in venous thromboembolism. Semin Thromb Hemost 2000;26:305–311.
18.
Tallman M, Brenner B, De la Serna J, Dombret H, Falanga A, Kwaan HC, Liebmann H, Raffoux E, Rickles FR: Meeting report. Leukemia Res 2005;29:347–351.
19.
Gugliotta L, Mazzucconi MG, Leone G, Mattioli-Belmonte M, Defazio P, Annino L, Tura S, Mandelli F: Incidence of thrombotic complications in adult patients with lymphoblastic leukemia receiving L-asparaginase during induction therapy: a retrospective study. The GIMEMA Group. Eur J Haematol 1992;49:63–66.
20.
Dally N, Hoffman R, Haddad N, Sarig G, Rowe JM, Brenner B: Predictive factors of bleeding and thrombosis during induction therapy in acute promyelocytic leukemia – a single center experience in 34 patients. Thromb Res 2005;116:109–114.
21.
Rees D, Grimwade D, Langabeer S, Burnett A, Goldstone A, on behalf of the MRC Adult Leukemia Working Party: Influence of genetic predisposition to thrombosis on natural history of acute promyelocytic leukemia. Br J Haematol 1997;96:490–492.
22.
Nowak-Gottl U, Ahlke E, Fleischhack G, Schwabe D, Schobess R, Schumann C, Junker R: Thromboembolic events in children with acute lymphoblastic leukemia (BFM protocols): prednisone versus dexamethasone administration. Blood 2003;101:2529–2533.
23.
Mitchell LG, Andrew M, Hanna K, Abshire T, Halton J, Anderson R, Cherrick I, Desai S, Mahoney D, Mc Custer P, Wu J, Dahl G, Chait P, Veber G, Lee KJ, Mikulis D, Ginsberg J, Way C; PAARKA Group: A prospective cohort study determining the prevalence of thrombotic events in children with acute lymphoblastic leukemia and a central venous line who are treated with L-asparaginase: results of the Prophylactic Antithrombin Replacement in Kids with Acute Lymphoblastic Leukemia treated with Asparaginase (PARKAA) Study. Cancer 2003;97:508–516.
© 2007 S. Karger AG, Basel
2007
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.