Pediatric Hematology/Oncology and ImmunopathologyPediatric Hematology/Oncology and ImmunopathologyВопросы гематологии/онкологии и иммунопатологии в педиатрии1726-17082414-9314Fund Doctors, Innovations, Science for Children10210.24287/1726-1708-2015-14-2-43-47ЛИМФОМЫCerebral venous sinus thrombosis and bleeding in the brain in a patient with lymphoblastic lymphomaТромбоз венозных синусов головного мозга и кровоизлияние в ткань головного мозга у пациента с лимфобластной лимфомойEvstratovD. A.ЕвстратовДмитрий Андреевич
Russian Federation
Evstratov.D.A@yandex.ruZharkovP. A.ЖарковПавел Александрович
Russian Federation
pzharkoff@gmail.comDyakonovaYu. Yu.ДьяконоваЮлия Юрьевна
Russian Federation
diakonova80@mail.ruAbugovaYu. G.АбуговаЮлия Георгиевна
Russian Federation
abugova_y@mail.ruSmirnovaN. V.СмирноваНадежда Владимировна
Russian Federation
nadin-dok@mail.ruFominykhV. V.ФоминыхВероника Валерьевна
Russian Federation
fomynih@yandex.ruMyakovaN. V.МяковаНаталья Валерьевна
Russian Federation
nmiakova@mail.ruФедеральный научно-клинический центр детской гематологии, онкологии и иммунологии им. Дмитрия Рогачева Минздрава России19052015142434719092018Copyright ©; 2015, «D. Rogachev NMRCPHOI»Copyright ©; 2015, ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава России2015«D. Rogachev NMRCPHOI»ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава Россииhttps://creativecommons.org/licenses/by/4.0https://hemoncim.com/jour/article/view/102

Patients with lymphoblastic lymphomas are effectively treated according to protocols developed by the BFM (Berlin-Frankfurt-Münster) group. Venous sinus thrombosis is a rare complication of therapy for lymphoblastic lymphomas. A clinical case is presented: development of combined thrombohemorrhagic complication in a boy aged 12 years with lymphoblastic lymphoma. The patient received replacement therapy with prothrombin complex factor, antithrombin III, and anticoagulant therapy with high-molecular-weight heparin gradually replaced by low-molecular-weight heparin. Five months of anticoagulant therapy led to complete recanalization of the involved sinuses.

Пациенты с лимфобластными лимфомами успешно лечатся по протоколам, разработанным немецкой группой BFM (Berlin-Frankfurt-Münster). Редким осложнением терапии лимфобластных лимфом является тромбоз венозного синуса. Представлен клинический случай развития сочетанного тромбогеморрагического состояния у мальчика 12 лет с лимфобластной лимфомой. Ребенку проводили заместительную терапию фактором протромбинового комплекса, препаратом антитромбина III и антикоагулянтную терапию высокомолекулярным гепарином с переходом на низкомолекулярный гепарин. Через 5 мес антикоагулянтной терапии у ребенка зарегистрирована полная реканализация пораженных синусов.

детилимфобластная лимфомагеморрагический инсульттромбоз венозного синусаL-аспарагиназаchildrenlymphoblastic lymphomahemorrhagic strokevenous sinus thrombosisL-asparaginaseReiter A, Schrappe M, Ludwig WD, Tiemann M, Parwaresch R, Zimmermann M, et al. Intensive ALL-type therapy without local radiotherapy provides a 90% eventfree survival for children with T-cell lymphoblastic lymphoma: a BFM group report. Blood. 2000;95(2):416-21.Caruso V, Iacoviello L, Di Castelnuovo A, Storti S, Mariani G, de Gaetano G, et al. Thrombotic complications in childhood acute lymphoblastic leukemia: a meta-analysis of 17 prospective studies comprising 1752 pediatric patients. Blood. 2006;108(7):2216-22.Gugliotta L, Mazzucconi MG, Leone G, Mattioli-Belmonte M, Defazio D, Annino L, et al. Incidence of thrombotic complications in adult patients with acute lymphoblastic leukaemia receiving L-asparaginase during induction therapy: a retrospective study. The GIMEMA Group. Eur J Haematol. 1992;49(2):63-6.Shapiro AD, Clarke SL, Christian JM, Odom LF, Hathaway WE. Thrombosis in children receiving L-asparaginase. Determining patients at risk. Am J Pediatr Hematol Oncol. 1993;15(4):400-5.Korte W, Feldges A, Baumgartner C, Ullmann S, Niederer V, Schmid L. Increased thrombin generation during fibrinogen and platelet recovery as an explanation for hypercoagulability in children with L-asparaginase therapy for ALL or NHL: a preliminary report. Klin Padiatr. 1994;206(4):331-3.Mitchell L, Hoogendoorn H, Giles AR, Vegh P, Andrew M. Increased endogenous thrombin generation in children with acute lymphoblastic leukemia: risk of thrombotic complications in L’Asparaginase-induced antithrombin III deficiency. Blood. 1994;83(2):386-91.Mitchell LG, Andrew M, Hanna K, Abshire T, Halton J, Anderson R, et al. A prospective cohort study determining the prevalence of thrombotic events in children with acute lymphoblastic leukemia and a central venous line who are treated with L-asparaginase: results of the Prophylactic Antithrombin Replacement in Kids with Acute Lymphoblastic Leukemia Treated with Asparaginase (PARKAA) Study. Cancer. 2003;97(2):508-16.Sutor AH, Mall V, Thomas KB. Bleeding and thrombosis in children with acute lymphoblastic leukaemia, treated according to the ALL-BFM-90 protocol. Klin Padiatr. 1999;211(4):201-4.Wermes C, von Depka Prondzinski M, Lichtinghagen R, Barthels M, Welte K, Sykora KW. Clinical relevance of genetic risk factors for thrombosis in paediatric oncology patients with central venous catheters. Eur J Pediatr.1999;158(Suppl. 3):S143-6.Mauz-Körholz C, Junker R, Göbel U, Nowak-Göttl U. Prothrombotic risk factors in children with acute lymphoblastic leukemia treated with delayed E. coli asparaginase (COALL-92 and 97 protocols). Thromb Haemost. 2000;83(6):840-3.Nowak-Göttl U, Heinecke A, von Kries R, Nürnberger W, Münchow N, Junker R. Thrombotic events revisited in children with acute lymphoblastic leukemia: impact of concomitant Escherichia coli asparaginase/prednisone administration. Thromb Res. 2001;103(3):165-72.Nowak-Göttl U, Ahlke E, Fleischhack G, Schwabe D, Schobess R, Schumann C, et al. Thromboembolic events in children with acute lymphoblastic leukemia (BFM protocols): prednisone versus dexamethasone administration. Blood. 2003;101 (7):2529-33.Silverman LB, Gelber RD, Dalton VK, Asselin BL, Barr RD, Clavell LA, et al. Improved outcome for children with acute lymphoblastic leukemia: results of Dana-Farber Consortium Protocol 91-01. Blood. 2001;97(5):1211-8.Bezeaud A, Drouet L, Leverger G, Griffin JH, Guillin MC. Effect of L-asparaginase therapy for acute lymphoblastic leukemia on plasma vitamin K-dependent coagulation factors and inhibitors. J Pediatr. 1986;108(5, Pt 1):698-701.Ramsay NK, Coccia PF, Krivit W, Nesbit ME, Edson JR. The effect of L-asparaginase of plasma coagulation factors in acute lymphoblastic leukemia. Cancer. 1977;40(4):1398-401.Priest JR, Ramsay NK, Bennett AJ, Krivit W, Edson JR. The effect of L-asparaginase on antithrombin, plasminogen, and plasma coagulation during therapy for acute lymphoblastic leukemia. J Pediatr. 1982;100(6):990-5.Bushman JE, Palmieri D, Whinna HC, Church FC. Insight into the mechanism of asparaginase-induced depletion of antithrombin III in treatment of childhood acute lymphoblastic leukemia. Leuk Res. 2000;24(7):559-65.Bettigole RE, Himelstein ES, Oettgen HF, Clifford GO. Hypofibrinogenemia due to L-asparaginase: studies of fibrinogen survival using autologous 131-I-fibrinogen. Blood. 1970;35(2):195-200.De Veber G, Andrew M, Adams C, Bjornson B, Booth F, Buckley DJ, et al. Cerebral sinovenous thrombosis in children. N Engl J Med. 2001;345(6):417-23.Grunt S, Wingeier K, Wehrli E, Boltshauser E, Capone A, Fluss J, et al. Cerebral sinus venous thrombosis in Swiss children. Dev Med Child Neurol. 2010; 52(12):1145-50.Sébire G, Tabarki B, Saunders DE, Leroy I, Liesner R, Saint-Martin C, et al. Cerebral venous sinus thrombosis in children: risk factors, presentation, diagnosis and outcome. Brain. 2005;128(Pt 3):477-89.Wasay M, Dai AI, Ansari M, Shaikh Z, Roach ES. Cerebral venous sinus thrombosis in children: a multicenter cohort from the United States. J Child Neurol. 2008; 23(1):26-31.Ranta S, Tuckuviene R, Mäkipernaa A, Albertsen BK, Frisk T, Tedgârd U, et al. Cerebral sinus venous thromboses in children with acute lymphoblastic leukaemia - a multicentre study from the Nordic Society of Paediatric Haematology and Oncology. Br J Haematol. 2015;168(4):547-52.