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DOI: 10.1055/s-0044-1788043
Recurrent Cerebral Venous Sinus Thrombosis Occurred in an Acute Lymphoblastic Leukemia Child with Mutated Lipoprotein Lipase Gene during Asparaginase Therapy
Funding This work was supported by the CAMS Innovation Fund for Medical Sciences (2022-I2M-1-022), the National Natural Science Foundation of China (82270144).
Abstract
Cerebral venous sinus thrombosis (CVST) and hyperlipidemia are severe complications of L-Asparaginase (L-Asp) during the treatment of B-cell acute lymphoblastic leukemia (B-ALL). Herein, we reported a 9-year-old B-ALL boy who underwent abnormal hypertriglyceridemia and CVST presenting as seizures and disturbance of consciousness twice during the induction therapy. Fortunately, he survived treatment with anticoagulant and lipid-lowering therapy. No thrombophilia-related gene mutation was detected, but a heterozygous mutation in lipoprotein lipase (LPL) gene was identified. His neurological symptoms were managed with short-term anticoagulant therapy and long-term lipid-lowering therapy. This case illustrated the manifestation and potential pathogenesis of CVST and highlighted the essentiality of screening baseline lipid profile and dyslipidemia- and thrombophilia-related gene mutation.
Keywords
acute lymphoblastic leukemia - gene mutation - L-Asparaginase - cerebral venous sinus thrombosis* These authors contributed equally to this work.
Publikationsverlauf
Artikel online veröffentlicht:
05. Juli 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Georg Thieme Verlag KG
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References
- 1 Malard F, Mohty M. Acute lymphoblastic leukaemia. Lancet 2020; 395 (10230): 1146-1162
- 2 Inaba H, Mullighan CG. Pediatric acute lymphoblastic leukemia. Haematologica 2020; 105 (11) 2524-2539
- 3 Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA Cancer J Clin 2021; 71 (01) 7-33
- 4 Parsons SK, Skapek SX, Neufeld EJ. et al. Asparaginase-associated lipid abnormalities in children with acute lymphoblastic leukemia. Blood 1997; 89 (06) 1886-1895
- 5 Greiner J, Schrappe M, Claviez A. et al; THROMBOTECT Study Investigators. THROMBOTECT - a randomized study comparing low molecular weight heparin, antithrombin and unfractionated heparin for thromboprophylaxis during induction therapy of acute lymphoblastic leukemia in children and adolescents. Haematologica 2019; 104 (04) 756-765
- 6 Couturier MA, Huguet F, Chevallier P. et al. Cerebral venous thrombosis in adult patients with acute lymphoblastic leukemia or lymphoblastic lymphoma during induction chemotherapy with L-asparaginase: the GRAALL experience. Am J Hematol 2015; 90 (11) 986-991
- 7 Hoogerbrugge N, Jansen H, Hoogerbrugge PM. Transient hyperlipidemia during treatment of ALL with L-asparaginase is related to decreased lipoprotein lipase activity. Leukemia 1997; 11 (08) 1377-1379
- 8 Tozuka M, Yamauchi K, Hidaka H, Nakabayashi T, Okumura N, Katsuyama T. Characterization of hypertriglyceridemia induced by L-asparaginase therapy for acute lymphoblastic leukemia and malignant lymphoma. Ann Clin Lab Sci 1997; 27 (05) 351-357
- 9 Kloos RQH, Pieters R, Jumelet FMV, de Groot-Kruseman HA, van den Bos C, van der Sluis IM. Individualized asparaginase dosing in childhood acute lymphoblastic leukemia. J Clin Oncol 2020; 38 (07) 715-724
- 10 Silverman LB, Gelber RD, Dalton VK. et al. Improved outcome for children with acute lymphoblastic leukemia: results of Dana-Farber Consortium protocol 91-01. Blood 2001; 97 (05) 1211-1218
- 11 Abbott LS, Deevska M, Fernandez CV. et al. The impact of prophylactic fresh-frozen plasma and cryoprecipitate on the incidence of central nervous system thrombosis and hemorrhage in children with acute lymphoblastic leukemia receiving asparaginase. Blood 2009; 114 (25) 5146-5151
- 12 Kawabori M, Kuroda S, Kudo K. et al. Susceptibility-weighted magnetic resonance imaging detects impaired cerebral hemodynamics in the superior sagittal sinus thrombosis–case report. Neurol Med Chir (Tokyo) 2009; 49 (06) 248-251
- 13 Talamo L, Douvas M, Macik BG, Ornan D. Successful treatment with apixaban of sinus venous thrombosis due to pegylated asparaginase in a young adult with T cell acute lymphoblastic leukemia: case report and review of management. Ann Hematol 2017; 96 (04) 691-693
- 14 Sui J, Zhang Y, Yang L. et al. Successful treatment with rivaroxaban of cerebral venous thrombosis and bone marrow necrosis induced by pegaspargase: a case report and literature review. Medicine (Baltimore) 2017; 96 (46) e8715
- 15 Parrella A, Iannuzzi A, Annunziata M. et al. Haematological drugs affecting lipid metabolism and vascular health. Biomedicines 2022; 10 (08) 1935
- 16 Caruso V, Iacoviello L, Di Castelnuovo A. et al. Thrombotic complications in childhood acute lymphoblastic leukemia: a meta-analysis of 17 prospective studies comprising 1752 pediatric patients. Blood 2006; 108 (07) 2216-2222
- 17 Athale UH, Chan AK. Thrombosis in children with acute lymphoblastic leukemia Part III. Pathogenesis of thrombosis in children with acute lymphoblastic leukemia: effects of host environment. Thromb Res 2003; 111 (06) 321-327
- 18 Rank CU, Toft N, Tuckuviene R. et al. Thromboembolism in acute lymphoblastic leukemia: results of NOPHO ALL2008 protocol treatment in patients aged 1 to 45 years. Blood 2018; 131 (22) 2475-2484
- 19 Gupta S, Wang C, Raetz EA. et al. Impact of asparaginase discontinuation on outcome in childhood acute lymphoblastic leukemia: a report from the Children's Oncology Group. J Clin Oncol 2020; 38 (17) 1897-1905