Acute Promyelocytic Leukemia in a Patient with Hemophilia

1972 ◽  
Vol 27 (03) ◽  
pp. 516-522
Author(s):  
D. Green

SummaryFactor VIII levels are usually elevated in patients with leukemia, and recently markedly increased levels of factor VIII were described during the relapses of acute lymphoblastic leukemia in a boy with previously documented hemophilia. In this paper we describe a young man with severe classical hemophilia who developed acute promyelocytic leukemia. In contrast to the findings noted above, infused factor VIII in this patient rapidly disappeared, with a half-life of only 4-8 h (expected: 12 h). In addition, the half-life of fibrinogen was 20 h (expected: 72 h), there was marked thrombocytopenia, and decreased levels of factor V. It is suggested that the rapid consumption of factor VIII is consistent with the syndrome of “consumption coagulopathy” which was present as a complication of his acute promyelocytic leukemia.

1967 ◽  
Vol 53 (6) ◽  
pp. 541-549
Author(s):  
Antonio Girolami

The behavior of factor V activity (proaccelerin) was investigated in 94 patients with acute and chronic leukemia. In acute myeloblastic and chronic myeloid leukemia normal or low levels of factor V were usually found. On the contrary in acute lymphoblastic and chronic lymphocytic leukemia normal or high levels were frequently observed. In ten patients (4 cases with acute myeloblastic leukemia, 5 cases with chronic myeloid leukemia and 1 case with acute lymphoblastic leukemia) there were markedly decreased levels of proaccelerin (less than 40%). In two patients with acute promyelocytic leukemia normal or elevated factor V activity was found. The significance of these variations in proaccelerin levels observed in leukemia is discussed.


Blood ◽  
2011 ◽  
Vol 118 (19) ◽  
pp. 5080-5083 ◽  
Author(s):  
Marie-Chantal Ethier ◽  
Esther Blanco ◽  
Thomas Lehrnbecher ◽  
Lillian Sung

Abstract Treatment-related mortality (TRM) is important in acute lymphoblastic leukemia and acute myeloid leukemia (AML); however, little is known about how TRM is defined across trials. Two major problems are related to what constitutes treatment versus disease-related cause of death and to TRM attribution (for example, death because of infection or hemorrhage). To address the former, we conducted a systematic review of randomized therapeutic pediatric acute leukemia and adult/pediatric acute promyelocytic leukemia trials and any study type focused on TRM in pediatric acute leukemia. We described definitions used for TRM. Sixty-six studies were included. Few therapeutic pediatric acute lymphoblastic leukemia studies (2/32, 6.3%) provided definitions for TRM, whereas more therapeutic pediatric AML studies (6/9, 66.7%) provided definitions. There was great heterogeneity in TRM classification. The authors of most studies relied on deaths during induction or in remission to delineate whether a death was TRM. However, 44.4% of therapeutic AML studies used death within a specific time frame to delineate TRM. We suggest that a consistent approach to defining and determining attribution for TRM in acute leukemia is an important future goal. Harmonization of definitions across the age spectrum would allow comparisons between pediatric and adult studies.


Blood ◽  
2012 ◽  
Vol 120 (10) ◽  
pp. 1993-2002 ◽  
Author(s):  
Tsila Zuckerman ◽  
Chezi Ganzel ◽  
Martin S. Tallman ◽  
Jacob M. Rowe

Abstract Acute myeloid leukemia and acute lymphoblastic leukemia remain devastating diseases. Only approximately 40% of younger and 10% of older adults are long-term survivors. Although curing the leukemia is always the most formidable challenge, complications from the disease itself and its treatment are associated with significant morbidity and mortality. Such complications, discussed herein, include tumor lysis, hyperleukocytosis, cytarabine-induced cellebellar toxicity, acute promyelocytic leukemia differentiation syndrome, thrombohemorrhagic syndrome in acute promyelocytic leukemia, L-asparaginase-associated thrombosis, leukemic meningitis, neutropenic fever, neutropenic enterocolitis, and transfussion-associated GVHD. Whereas clinical trials form the backbone for the management of acute leukemia, emergent clinical situations, predictable or not, are common and do not readily lend themselves to clinical trial evaluation. Furthermore, practice guidelines are often lacking. Not only are prospective trials impractical because of the emergent nature of the issue at hand, but clinicians are often reluctant to randomize such patients. Extensive practical experience is crucial and, even if there is no consensus, management of such emergencies should be guided by an understanding of the underlying pathophysiologic mechanisms.


Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3357-3357
Author(s):  
Esther Bloem ◽  
Henriet Meems ◽  
Maartje van den Biggelaar ◽  
Koen Mertens ◽  
Alexander B Meijer

Abstract Abstract 3357 Previously, we identified a role for the lysine residue couple 1967/1968 in the stability of activated factor VIII (FVIIIa). Using tandem mass tags (TMT 126/127) in combination with mass spectrometry, we identified lysine residues involved in the interaction between the A2 domain and the rest of heterodimer (A1/A3-C1-C2) of FVIIIa (Bloem et al., J Biol Chem 2012;287:5575–83). Upon FVIII activation and A2 domain dissociation, the highest increase in surface exposure occurred for the lysine couple 1967/1968, and functional studies confirmed the role thereof in FVIIIa stability. In addition to lysines 1967/1968 also other lysines displayed an increased surface exposure, including those in positions 1804, 1808, 1813 and 1818. The A3 domain region 1803–1818 has previously been implicated in interactions with ligands such as activated factor IX (FIXa). As such, one might expect increased surface exposure due to FVIII activation. On the other hand, A2 domain dissociation may have rearranged the A3 domain surface in this region. The relation between FIXa assembly and A2 domain retention was therefore explored in the present study. To unravel the role of region 1803–1818 in FVIIIa stability and FIXa binding, either region 1803–1810 or 1811–1818 was replaced by the corresponding regions of the homologous factor V. Additionally, as Asn1810 is N-linked glycosylated and this glycan is maintained in both chimeras, a variant that lacks this glycan (N1810C) was investigated. Factor × activation kinetics were used to investigate the apparent FIXa binding affinity of the FVIII variants. FXa generation was assessed on 15% phosphatidyl serine (PS) containing membranes. FIXa titration experiments showed that the affinity for the 1811–1818 variant is reduced (apparent Kd from 1.3 nM to 2.4 nM). Removal of the glycan and substitution of 1803–1810 has little or no effect on the apparent FIXa binding. FVIIIa-FIXa assembly on membranes containing 15% PS was studied using lipid- coated glass beads (lipospheres). Lipospheres were incubated with fluorescein-labeled FIXa and different FVIIIa concentrations. FIXa did only display liposphere binding in the presence of FVIIIa. Therefore, the mean fluorescent intensity on the lipospheres at increasing FVIIIa concentration could be used as a measure for FVIIIa-FIXa assembly on lipids. Results from these experiments showed that the 1811–1818 variant fails to promote FVIIIa-FIXa assembly, whereas the other variants behave like WT. To investigate FVIIIa stability, and thereby the role of the mutations on A2 domain dissociation, the activity of the variants was followed over time. Results showed that the 1811–1818 variant has a decreased half life of 1.5 min, compared to 6.9 min for WT. Also substitution of region 1803–1810 results in a lower half life, although to a lesser extent (2.8 min), whereas the glycan lacking variant behaves like WT (6.8 min). Incubation of FVIIIa variants with FIXa is known to stabilize FVIIIa and leads to an increased half life for all variants. However, the 1803–1810 variant is most efficiently stabilized by FIXa, shown by a 3-fold increase in half life, instead of 1.6-fold as seen for both WT and N1810C. The 1811–1818 variant is stabilized by 2.2-fold and therefore remains significantly less stable than WT. Together these results show that the 1811–1818 region is not only involved in FIXa binding, but additionally plays a major role in A2 domain retention. Region 1803–1810 also plays a role in FVIIIa stability, although to a lesser extent. Remarkably, the glycan at position Asn1810 does not influence neither FIXa binding nor FVIIIa stability, and apparently serves some other function. Disclosures: No relevant conflicts of interest to declare.


Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4791-4791
Author(s):  
Katarzyna Smalisz-Skrzypczyk ◽  
Anna Klukowska ◽  
Katarzyna Pawelec ◽  
Michal Matysiak

The aim of the study was to evaluate factors predisposing to thrombosis in children treated for acute lymphoblastic leukemia according to ALL IC BFM 2002. An analysis of 30 cases of thrombosis in 210 children (14%) treated due to ALL in the Department in years 2007-2011 was carried out. Age at onset, location, cause and treatment methods were taken into consideration. All analyzed patients underwent screening for congenital thrombophilia. The age of patients ranged from 1.5 to 16 years with the median of 7.5 years. Arterial thrombosis occurred in 1 person (3%), venous thrombosis in 29 (97%) patients. Thromboembolism was usually related to the central venous catheter (n = 27, 90%). Massive thrombosis occurred in 6 patients (20%). Relapses occurred in 2 children. The most common causes of thrombosis were: the presence of the central catheter (n = 27, 90%) and L-asparaginase treatment (n = 16, 53%). The factor V Leiden mutation was diagnosed in 1 patient, protein C deficiency in 1 patient as well, and elevated levels of factor VIII were detected in 3 cases. Five children (16%) underwent systemic thrombolysis with recombinant tissue plasminogen activator and 17 patients (52%) had local thrombolysis. Anticoagulation with warfarin following low-molecular-weight heparin discontinuation was used in 6 patients (20%). The complete resolution of the thrombus was observed in the whole group of patients. Conclusions 1. A risk factor for thrombosis in children with ALL is the treatment of L-asparaginase and the presence of central venous catheter. 2. Screening for congenital thrombophilia in children treated for ALL should not be done routinely since the coexistence of this two conditions is rare. Thrombosis in children with ALL responds well to treatment. Disclosures: Klukowska: Octapharma AG: Investigator Other.


Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5251-5251
Author(s):  
Katarzyna Smalisz-Skrzypczyk ◽  
Anna Klukowska ◽  
Katarzyna Pawelec ◽  
Michal Matysiak

Abstract The aim of the study was to evaluate factors predisposing to thrombosis, especially congenital trombophilia, in children treated for acute lymphoblastic leukemia according to ALL IC BFM 2002 and 2009. An analysis of 36 cases of thrombosis in 242 children (15%) treated due to ALL in the Department in years 2007-2013 was carried out. Age at onset, location, cause and treatment methods were taken into consideration. All analyzed patients underwent screening for congenital thrombophilia. The age of patients ranged from 1.5 to 17 years with the median of 8.5 years. Arterial thrombosis occurred in 2 persons (1%), venous thrombosis in 34 (99%) patients. Thromboembolism was usually related to the central venous catheter (n = 31, 91%). Massive thrombosis occurred in 7 patients (20%). Relapses occurred in 3 children. The most common causes of thrombosis were: the presence of the central catheter (n = 31, 91%) and L-asparaginase treatment (n = 19, 55%). The factor V Leiden mutation was diagnosed in 1 patient, protein C deficiency in 1 patient as well, and elevated levels of factor VIII were detected in 4 cases. The mean concentrations of factor VIII, von Willebrand factor and antithrombin were not different in the groups with and without thrombosis (table 1 ). The concentration of fibrinogen measured after finishing the chemotherapy was similar in both groups. Conclusions 1. A risk factor for thrombosis in children with ALL is the treatment of L-asparaginase and the presence of central venous catheter. 2. Screening for congenital thrombophilia in children treated for ALL should not be done routinely because the coexistence of this two conditions is rare. Table 1FVIII (%)Fibrinogen ( g/l)AT (%)Patients with thrombosis1012,776Patients without thrombosis892,4382p0,45 ( ns)0,2 (ns)0,34 (ns) Disclosures No relevant conflicts of interest to declare.


Blood ◽  
1964 ◽  
Vol 23 (6) ◽  
pp. 717-728 ◽  
Author(s):  
PAUL DIDISHEIM ◽  
JOHN S. TROMBOLD ◽  
ROBERT L. E. VANDERVOORT ◽  
R. SOUGIN MIBASHAN

Abstract 1. Two patients with acute promyelocytic leukemia (APL) are reported. Many of the promyelocytes were atypical. Of the 57 patients with this disorder in the literature, only three survived more than 4 months. Our patients underwent complete remission on 6-mercaptopurine, and survived 8 and 14 months, respectively. 2. Coagulation abnormalities in these two patients were thrombocytopenia; fibrinogen and factor V deficiencies; and, in one, prothrombin deficiency. These defects disappeared with remission, then reappeared terminally. In contrast to most previous reports, no increased fibrinolytic activity was found in their blood. Infused fibrinogen disappeared abnormally rapidly from the blood of one patient; this was not affected by simultaneous heparin administration, and no thrombi were seen at autopsy. 3. Fibrinogen, factor V, and prothrombin were assayed in 86 patients with other forms of leukemia before treatment or in relapse. Fibrinogen deficiency was found in none; prothrombin and/or factor V deficiency in eight. Three of these had acute myeloblastic, three acute myelomonoblastic, and two chronic myelocytic leukemia. 4. The characteristic cellular morphology, combined with the usual finding of fibrinogen and factor V deficiencies, makes for a distinct differentiation of APL from other forms of leukemia.


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