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Supportive care for hemostatic complications associated with pediatric leukemia: a national survey in Japan

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Abstract

Optimal supportive care for disseminated intravascular coagulation (DIC) and hemostatic complications by asparaginase is indispensable for the successful treatment of pediatric leukemia. However, the situation regarding this type of care in Japan is unclear. We conducted a questionnaire-based survey at 155 institutions treating childhood leukemia in Japan. The questionnaire asked about the supportive care provided by each institution to acute leukemia patients with DIC and asparaginase-induced hemostatic alterations. Ninety-eight institutions responded. The most common diagnostic criteria for DIC were those established by the Japanese Ministry of Health and Welfare. Regardless of the etiology underlying DIC, recombinant human thrombomodulin and synthetic protease inhibitors were used as anticoagulation therapy by around 70% and 40% of institutions, respectively. Additionally, 92%, 93%, and 73% of institutions measured plasma antithrombin, fibrinogen, and D-dimer/fibrin degradation products, respectively, more than twice per week during induction therapy for acute lymphoblastic leukemia. Survey responses indicate that 95% and 24% of the institutions used antithrombin replacement and fresh-frozen plasma, respectively. Supportive care for DIC and/or asparaginase-induced hemostatic alterations at Japanese pediatric centers was intensive and differs markedly from protocols in other countries. The efficacy of supportive care should be evaluated prospectively in the setting of pediatric leukemia.

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Abbreviations

ALL:

Acute lymphoblastic leukemia

DIC:

Disseminated intravascular coagulation

JPLSG:

The Japanese Pediatric Leukemia/Lymphoma Study Group

FDP:

Fibrin degradation products

FFP:

Fresh-frozen plasma

JMHW:

The Japanese Ministry of Health and Welfare

JSTH:

The Japanese Society on Thrombosis and Hemostasis

JAAM:

The Japanese Association for Acute Medicine

ISTH:

The International Society on Thrombosis and Hemostasis

rhTM:

Recombinant human thrombomodulin

BFM:

Berlin–Frankfurt–Münster

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Acknowledgements

We thank all participants listed in Supplemental material 2 for answering the questions.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

    Shinya Osone

  2. Department of Pediatrics, Dokkyo Medical University School of Medicine, Tochigi, Japan

    Keitaro Fukushima

  3. Department of Pediatrics, Akita University Hospital, Akita, Japan

    Michihiro Yano

  4. Pediatric Hematology and Oncology Department, Okinawa Prefectural Medical Center and Children’s Medical Center, Okinawa, Japan

    Mariko Kakazu

  5. Department of Pediatrics, Sapporo Hokuyu Hospital, Hokkaido, Japan

    Hirozumi Sano

  6. Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan

    Yoko Kato

  7. Department of Pediatrics, Kagoshima City Hospital, Kagoshima, Japan

    Yuichi Shinkoda

  8. Department of Pediatrics, Gifu Municipal Hospital, Gifu, Japan

    Kunihiro Shinoda

  9. Akabane Zaitaku Clinic, Tokyo, Japan

    Naoko Mori

  10. Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Souichi Adachi

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  1. Shinya Osone
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Correspondence to Shinya Osone.

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Osone, S., Fukushima, K., Yano, M. et al. Supportive care for hemostatic complications associated with pediatric leukemia: a national survey in Japan. Int J Hematol 110, 743–750 (2019). https://doi.org/10.1007/s12185-019-02740-9

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  • DOI: https://doi.org/10.1007/s12185-019-02740-9

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