Cerebral venous sinus thrombosis in acute lymphoblastic leukemia treated by pegaspargase: report of 3 cases and review of literature
10.3760/cma.j.cn115356-20230224-00049
- VernacularTitle:培门冬酶治疗急性淋巴细胞白血病致颅内静脉窦血栓形成3例并文献复习
- Author:
Zhen YAO
1
;
Chongsheng QIAN
;
Hanyu CAO
;
Tongtong ZHANG
;
Wenjie GONG
;
Haixia ZHOU
;
Mingzhu XU
;
Shengli XUE
Author Information
1. 苏州大学附属第一医院血液内科，苏州 215006
- Keywords:
Precursor cell lymphoblastic leukemia-lymphoma;
Pegaspargase;
Sinus thrombosis, intracranial;
Progesterone congeners;
Risk factors
- From:
Journal of Leukemia & Lymphoma
2023;32(12):723-728
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the diagnosis, treatment, clinical characteristics and potential high-risk factors of cerebral venous sinus thrombosis (CVST) during the treatment of acute lymphoblastic leukemia (ALL) with pegaspargase.Methods:The medical history, diagnosis and treatment process, laboratory examination and imaging examination results of 3 ALL patients with CVST during pegaspargase treatment in the First Affiliated Hospital of Suzhou University in March and November 2021 and September 2022 were retrospectively analyzed, and the relevant literature was reviewed.Results:Three patients were all female, with the aged between 15 and 35 years old, including 2 cases of B-ALL and 1 case of T-ALL. All patients developed nervous system symptoms after pegaspargase chemotherapy, and were diagnosed as CVST by imaging examination. During the pegaspargase treatment, 2 patients took norethisterone, and 1 patient underwent induced labor and curettage. The levels of sexual hormones in the 3 patients had non-physiological changes. The main CVST lesions were located in the superior sagittal sinus, transverse sinus and sigmoid sinus. One patient had cerebral hemorrhage at the same time. When thrombus occurred, the fibrinogen (Fib), antithrombin Ⅲ (AT Ⅲ) activity, protein C activity and protein S activity of the patients were significantly lower than those before, D-dimer was significantly higher, and lupus anticoagulant and anticardiolipin antibody were negative. The thrombosis treatment was mainly anticoagulation, and 1 patient underwent thrombolysis. Two patients had no sequelae of nervous system, and 1 patient had the sequelae of muscle weakness.Conclusions:Patients with ALL should be alert to the occurrence of CVST when they have nervous system symptoms during pegaspargase chemotherapy. The diagnosis of CVST mainly depends on cranial imaging. Anticoagulation is the main thrombosis treatment, thrombolysis and interventional thrombectomy are feasible for some patients, with few neurological sequelae. The use of second-generation progesterone drugs and the non-physiological fluctuation of sex hormones may be the potential risk factors of CVST.
