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The use ofl-asparaginase (l-ASP) in paediatric patients with acute lymphoblastic leukaemia (ALL) is associated with thrombotic complications. We evaluated the activities of tissue factor (TFa), thrombomodulin (TMa) and procoagulant phospholipids (PPL) in 26 consecutive children with ALL (25 B-ALL and one T-ALL) treated by the French Acute Lymphoblastic Leukemia group (FRALLE)-2000 protocol. Samples were obtained at diagnosis, after glucocorticoid (GC) therapy, during the induction phase withl-ASP, vincristine (VCR) and adriamycin (ADR), during the re-induction and within the week after treatment. Plasma levels of TFa, TMa and PPL increased gradually and significantly during the different phases of the treatment, with higher levels observed during the induction period, and decreased after treatment discontinuation. In vitro studies showed that the different drugs used for ALL treatment could induce a weak expression of TF and procoagulant activity (PCA) on normal and leukaemia blood cells, while a marked effect was observed on endothelial cells. In conclusion, these data indicate that, in addition to the well-identified increased in coagulation factors and inhibitor deficiencies, the injury of the endothelium could lead to the release of TF and PPL and could contribute to the hypercoagulability of children treated for ALL. [ABSTRACT FROM AUTHOR]

As an elevation of urinary basic fibroblast growth factor (bFGF) levels and high BM microvessel density (MVD) was previously described in childhood acute lymphoblastic leukaemia (ALL), we performed a prospective study measuring urinary bFGF, and also vascular endothelial growth factor (VEGF), as plasma VEGF level was reported as a prognostic factor in adult acute myeloblastic leukaemia. If we consider the outcome of patients with normal bFGF levels, 6 / 18 (33.3%) children relapsed and three of them died of disease, whereas 2 / 21 (9.5%) patients with elevated levels of bFGF relapsed. When comparing the patients with normal VEGF values, 3 / 31 relapsed, whereas 5 / 8 patients with high levels of VEGF relapsed, suggesting that high levels of VEGF probably indicate poor prognosis.