Last update:
   09-Mar-2009
 

Arch Hellen Med, 25(6), November-December 2008, 771-780

ORIGINAL PAPER

Dysfunction of the vascular endothelium in children with acute lymphoblastic leukemia

E.S. HATZIPANTELIS,1,2 M. ATHANASIOU-METAXA,1 V. TZIMOULI,1 A. TAPARKOU,1 N. GOMBAKIS,1 V. SIDI,2 T. PAPAGEORGIOU,3
V. GARIPIDOU,4 D. KLETA,5 E. VAGDATLI,5 H. TSANTALI,1 D.E. KOLIOUSKAS,2 F. ATHANASIADOU-PIPEROPOULOU,3 F. KANAKOUDI-TSAKALIDOU1
11st Pediatric Department, Aristotle University of Thessaloniki,
2Pediatric Oncology Department, "Ippokration" General Hospital,
32nd Pediatric Department, Aristotle University of Thessaloniki,
42nd Internal Medicine Department, Aristotle University of Thessaloniki,
5Hematology Laboratory, "Ippokration" General Hospital, Thessaloniki, Greece

OBJECTIVE The aim of this study was to determine the levels of the activation markers of the vascular endothelium and coagulation pathway parameters in children with acute lymphoblastic leukemia (ALL), and to compare the results with known prognostic factors and disease outcome, targeting their possible prognostic value.

METHOD Fifty two children with ALL, 19 with ALL 1-10 years out of therapy, and 28 healthy children were studied. In all the patients and children of both control groups the following laboratory parameters were determined: (a) coagulation system: platelet number, prothrombin time, partial thromboplastin time, thrombin time, fibrinogen, von Willebrand factor (vWF), antithrombin ���, protein C, protein S, activated protein C resistance, �2-macroglobulin, thrombomodulin (TM), tissue-plasminogen activator, plasminogen activator inhibitor, plasminogen, �2-antiplasmin, D-dimers, and (b) endothelial factors: sP-selectin, vascular cell adhesion molecule-1, �2-integrins, nitric oxide, endothelin-1, platelet derived growth factor.

RESULTS-CONCLUSIONS Statistical analysis of the data and consideration of the results led to the following conclusions: In children with ALL, the significant increase of TM and vWF levels observed in the acute phase of the disease and during treatment confirms the serious dysfunction of the vascular endothelium, resulting from the disease itself. The significantly positive correlation of TM, vWF with the leucocyte count before treatment, and the high levels of TM in children with unfavorable outcome, possibly identify these factors as useful predictors in childhood ALL. The findings of the study also suggest the presence of a "hypercoagulable state", often subclinical, during the acute phase of ALL, while abnormal findings in remission possibly result from treatment.

Key words: ALL, Children, Vascular endothelium.

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