Hémorragie cérébrale fatale en cours d’induction d’une leucémie aiguë lymphoblastique

Acute Leukemia Revealed by Cerebral Hemorrhage

“…Among their most severe complications, the occurrence of hemorrhagic events, dominated by intracerebral hemorrhages, which represent an important cause of morbidity and mortality in patients followed for acute leukemia [4].…”

“…Several factors contribute to causing this hemorrhage asalterations in coagulation factors, thrombocytopenia, and the possible associated disseminated intravascular coagulation. Few of themcan be treated, and some are the result of treatment directed against the disease process itself [4,1].…”

“…Among the chemotherapy molecules used in the treatment of ALL, L-asparaginase is responsible for inhibiting synthesis of coagulation proteins. Its prothrombotic action is well described, but few cases of hemorrhage related to its use have been reported [4,1].…”

“…Management of patients with acute leukemia must be carried out in a specialized pediatric environment after multidisciplinary concertation meeting.Recently, the introduction of new therapeutic methods, such as aggressive polychemotherapy, intrathecal cytostatic prophylaxis and cranial irradiation have improved the prognosis of acute leukemia, without denying that these treatments can sometimes themselves be responsible for neurological complications. Surgery is the last approach to care intracranial hemorrhage: craniectomy, evacuation of hematoma, shunt ventricular are gestures of last resort [4,1]. The results of a randomized trial indicate that surgical treatment fast does not offer an advantage compared to medical treatment for the management of cerebral hemorrhages.Bone marrow transplantation has also revolutionized the treatment of these patients [1].…”

Intracranial Hemorrhage Following Oral Low-Dose Methotrexate After Multiple Toxicities Caused by High-Dose Methotrexate in Childhood Acute Lymphoblastic Leukemia

“…The most common drug that in hematologic malignancies leads to hemorrhagic complications is L-asparaginase. However, ICH following L-asparaginase is mostly due to the disturbances of coagulation function such as hypofibrinogenemia and prolonged plasma clotting times, and often occurs within 2–3 weeks during the early induction therapy based on clinical observation and some case reports (Cairo et al, 1980; Priest et al, 1980; Pardes-Chavanes et al, 2016). This patient received L-asparagine during reinduction therapy along with normal coagulation function.…”