Lack of pathogenetic role of proteins C and S in thrombosis associated with asparaginase-prednisone-vincristine therapy for leukaemia

Authors

  • Ching-Hon Pui,

    Corresponding author
    1. Department of Haematology-Oncology, St Jude Children's Research Hospital, Memphis, Tennessee; Departments of Medicine and Pediatrics, Division of Hematology, University of Tennessee Center for the Health Sciences, and Department of Pathology, Baptist Memorial Hospital, Memphis, Tennessee; and Departments of Medicine and Pathology, University of California, San Diego, California
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  • Carolyn M. Chesney,

    1. Department of Haematology-Oncology, St Jude Children's Research Hospital, Memphis, Tennessee; Departments of Medicine and Pediatrics, Division of Hematology, University of Tennessee Center for the Health Sciences, and Department of Pathology, Baptist Memorial Hospital, Memphis, Tennessee; and Departments of Medicine and Pathology, University of California, San Diego, California
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  • Peter W. Bergum,

    1. Department of Haematology-Oncology, St Jude Children's Research Hospital, Memphis, Tennessee; Departments of Medicine and Pediatrics, Division of Hematology, University of Tennessee Center for the Health Sciences, and Department of Pathology, Baptist Memorial Hospital, Memphis, Tennessee; and Departments of Medicine and Pathology, University of California, San Diego, California
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  • Carl W. Jackson,

    1. Department of Haematology-Oncology, St Jude Children's Research Hospital, Memphis, Tennessee; Departments of Medicine and Pediatrics, Division of Hematology, University of Tennessee Center for the Health Sciences, and Department of Pathology, Baptist Memorial Hospital, Memphis, Tennessee; and Departments of Medicine and Pathology, University of California, San Diego, California
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  • Samuel I. Rapaport

    1. Department of Haematology-Oncology, St Jude Children's Research Hospital, Memphis, Tennessee; Departments of Medicine and Pediatrics, Division of Hematology, University of Tennessee Center for the Health Sciences, and Department of Pathology, Baptist Memorial Hospital, Memphis, Tennessee; and Departments of Medicine and Pathology, University of California, San Diego, California
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Dr Ching-Hon Pui, St Jude Children's Research Hospital. 332 North Lauderdale, P.O. Box 318, Memphis, Tennessee 38101, U.S.A.

Abstract

Summary. Plasma levels of protein C and protein S antigens were measured in eight children who developed thrombosis following asparaginase-prednisone-vincristine treatment for acute lymphoblastic leukaemia and in nine similarly treated children without this complication. Protein C antigen levels were below normal in three of the eight patients with thrombosis and in three of the nine patients without the complication (P= 0-38). Low protein S antigen levels were found in five of six patients with thrombosis and in two of seven patients without thrombosis (P=0-10). Plasma factor IX and factor X antigen levels, other vitamin K dependent factors, were also measured in the two groups of patients. In general, reduced levels of protein C, protein S or both antigens (anticoagulant vitamin K dependent proteins) were associated with reduced levels of factor IX, factor X, or both of these factors (procoagulant vitamin K dependent clotting proteins). The ratios of protein C and protein S antigens to each other and to factor IX and factor X antigens did not differ between the two groups. Thus, there is no clear evidence that reduced levels of protein C and (or) protein S cause thrombosis in leukaemia patients treated with this drug combination.

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