A prospective longitudinal multicenter study of coagulation in pediatric patients undergoing allogeneic stem cell transplantation
Corresponding Author
Leonardo R. Brandão MD
Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
555 University Avenue, Toronto, Ontario, M5G 1X8 Canada.===Search for more papers by this authorMorris Kletzel MD
Children's Memorial Hospital, Chicago, Illinois
Search for more papers by this authorFarid Boulad MD
Memorial Sloan-Kettering Cancer Center, New York, New York
Search for more papers by this authorJoanne Kurtzberg MD
Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
Search for more papers by this authorKelly Maloney MD
Children's Hospital of Wisconsin, Milwaukee, Wisconsin
Search for more papers by this authorIgal Fligman MD
Winthrop University Hospital, Mineola, New York, New York
Search for more papers by this authorCristina P. Sison PhD
Feinstein Institute for Medical Research North Shore-Long Island Jewish Health System, Manhasset, New York, New York
Search for more papers by this authorDonna DiMichele MD
Department of Pediatrics, Weill Medical College of Cornell University, New York, New York
Search for more papers by this authorCorresponding Author
Leonardo R. Brandão MD
Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
555 University Avenue, Toronto, Ontario, M5G 1X8 Canada.===Search for more papers by this authorMorris Kletzel MD
Children's Memorial Hospital, Chicago, Illinois
Search for more papers by this authorFarid Boulad MD
Memorial Sloan-Kettering Cancer Center, New York, New York
Search for more papers by this authorJoanne Kurtzberg MD
Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
Search for more papers by this authorKelly Maloney MD
Children's Hospital of Wisconsin, Milwaukee, Wisconsin
Search for more papers by this authorIgal Fligman MD
Winthrop University Hospital, Mineola, New York, New York
Search for more papers by this authorCristina P. Sison PhD
Feinstein Institute for Medical Research North Shore-Long Island Jewish Health System, Manhasset, New York, New York
Search for more papers by this authorDonna DiMichele MD
Department of Pediatrics, Weill Medical College of Cornell University, New York, New York
Search for more papers by this authorAbstract
Background
Thrombotic complications occur in adult patients undergoing stem cell transplantation (SCT), especially following high dose chemo-radiotherapy. There is little published information in children on the impact of SCT on coagulation, as well as potential correlations between altered coagulation and SCT-associated thrombosis and organ failure.
Procedure
Forty three pediatric subjects who underwent allogeneic SCT were prospectively evaluated for congenital thrombophilia, anticoagulant levels, coagulation activation, and fibrinolysis at pre-established set points encompassing the period from the 2 to 4 weeks prior to conditioning to 28 days post-transplantation.
Results
A significant decrease of protein C and antithrombin levels was found in 39% and 31% of subjects respectively, between SCT days +6 and +7. A peak in plasminogen activator inhibitor-1 levels in 31% of subjects was noted between days +9 and +10. No subject experienced a thrombotic event or other SCT-related organ failure. Antithrombin deficiency correlated with underlying malignancy, donor HLA-mismatch, and TBI, whereas decreased PC activity demonstrated a trend of association with lack of T-cell depletion and TBI. Prophylactic heparin did not influence the pattern of acquired hemostatic abnormalities observed in this cohort.
Conclusions
Children undergoing allogeneic SCT develop a state of acquired thrombophilia in the early post-transplantation period. Although no SCT-related thromboembolic events were observed, our results provide new information about the hemostatic changes in children undergoing allogeneic SCT and their potential clinical triggers. The significance of these findings requires further prospective evaluation in a larger cohort of patients. Pediatr Blood Cancer 2008;50:1240–1246. © 2008 Wiley-Liss, Inc.
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