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Table 1 Potential interactions of thrombophilia and antileukemic agents

From: Evaluation for inherited and acquired prothrombotic defects predisposing to symptomatic thromboembolism in children with acute lymphoblastic leukemia: a protocol for a prospective, observational, cohort study

Thrombophilia

ALL or Chemotherapeutic agent

Possible interaction

PT gene polymorphism 20210A

ALL

PT mutation may exaggerate ALL-induced thrombin generation

Corticosteroid

May induce higher levels of PT

MTHFR C677T

Methotrexate

By inhibiting folate pathway induces functional MTHFR deficiency even in heterozygous patients with resultant high Hcy levels

FVL

Asparaginase

By reducing protein C levels may exaggerate the effects of FVL even in heterozygous subjects

Protein C, S and AT deficiency

Asparaginase

By inhibiting protein synthesis results in reduction in Proteins C, S and AT

Elevated pro-coagulant factors VIII:C, IX and XI

Corticosteroid

May induce higher levels of factors VIII:C, IX and XI

Elevated Lp(a) levels

Asparaginase

Lead to mark elevation in Lp(a)

  1. Abbreviations: ALL acute lymphoblastic leukemia, PT prothrombin, MTHFR methylene tetrahydrofolate reductase, Hcy homocysteine, FVL Factor V Leiden, AT antithrombin, FVIII:C Coagulation factor VIII:C, Lp(a) Lipoprotein a