International Journal of Hematology

DOI: 10.1007/s12185-019-02740-9 Pages: 743-750

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

1. Kyoto Prefectural University of Medicine, Department of Pediatrics, Graduate School of Medical Science

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

3. Akita University Hospital, Department of Pediatrics

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

5. Sapporo Hokuyu Hospital, Department of Pediatrics

6. Jikei University School of Medicine, Department of Pediatrics

7. Kagoshima City Hospital, Department of Pediatrics

8. Gifu Municipal Hospital, Department of Pediatrics

9. Akabane Zaitaku Clinic

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

Correspondence to:
Shinya Osone
Tel: +81-75-251-5571
Email: shinn-o@koto.kpu-m.ac.jp

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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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