Children with acute lymphoblastic leukaemia have high plasma levels of total homocysteine at time of diagnosis

Abstract

Objective. Cancer can induce venous thromboembolic complications for various reasons. As part of a greater study, acquired and congenital prothrombotic risk factors were investigated in children with leukaemia or non‐Hodgkin's lymphoma and compared with similar investigations in children with congenital heart defects. Material and methods. Blood samples were taken from 60 children with newly diagnosed leukaemia or lymphoma and 133 children with congenital heart defects in the course of a scheduled cardiac catheterization. When children with cancer were in remission, analyses of acquired prothrombotic risk factors were repeated. Children with cancer were observed for symptoms of thromboembolism throughout their treatment period. Results. Total homocysteine levels were significantly raised in children with cancer (median value 10.0 µmol/L) as compared with the levels in children with congenital heart diseases (5.0 µmol/L) (p<0.001), while children with acute lymphoblastic leukaemia had the highest values. The median level of lipoprotein(a) was slightly increased in children with newly diagnosed leukaemia or lymphoma (105 mg/L versus 100 mg/L, p<0.001), and levels of coagulation inhibitors were higher (p<0.001). Total homocysteine levels normalized when children attained remission of cancer disease. Two children had symptoms of acute thrombosis. Conclusions. Raised concentrations of total homocysteine were frequent in children with newly diagnosed cancer, but this normalized when the children were in remission. The clinical significance of our observations and the impact on venous thromboembolism have yet to be defined.

• Cancer
• congenital heart defects
• homocysteine
• thrombophilia

Acknowledgements

We express our thanks to Professor S. O. Lie and Professor E. Thaulow for their enthusiastic support of this study. We also express our gratitude to Marijke Veenstra and G. Aamodt for statistical guidance. We thank all the nurses, laboratory technicians and doctors at The National Hospital who participated in the study, with special thanks to the nurses at the Paediatric Cardiology Unit. The study was funded by the Norwegian Cancer Society (grant to Dr. Ruud).