Thrombosis of the sinus durae matris as a complication of therapy in patients with Hodgkin lymphoma


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Abstract

AIM. To describe thrombosis of the sinus durae matris (TSDM) in lymphomas. MATERIALS AND METHODS. 402 patients with Hodgkin lymphoma were treated using the ВЕАСОРР-14 protocol in 2006 to 2013. Thrombotic events occurred in 6% of the patients, including 3 (0.8%) who developed brain magnetic resonance imaging-verified TSDM. RESULTS. TSDM developed in 3 women aged 17, 18, and 25 years during 3-6 chemotherapy cycles involving glucocorticosteroids in a dose of 80 mg/m2 on days 1-7 and an oral contraceptive used continuously for 1.5-3 months. The symptoms of thrombosis were severe headache; 2 patients had convulsive syndrome with short-term loss of consciousness. Anticoagulant therapy with intravenous heparin 20,000-24,000 U/day led to thrombus recanalization within 4-10 days. No rethromoboses were observed during a subsequent follow-up. CONCLUSION. The ВЕАСОРР-14 treatment in young women with Hodgkin lymphoma who continuously take oral contraceptives should be combined with anticoagulant therapy, by monitoring their coagulogram.

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Тромбоз синусов твердой мозговой оболочки как осложнение терапии у больных лимфомой Ходжкина. - Резюме. Цель исследования. Описание тромбоза синусов твердой мозговой оболочки (ТСТМО) при лимфомах. Материалы и методы. С 2006 по 2013 г. терапия по программе ВЕАСОРР-14 проведена 402 больным лимфомой Ходжкина. Тромботические осложнения возникли у 6% пациентов, в том числе у 3 (0,8%) развился ТСТМО, подтвержденный данными магнитно-резонансной томографии головного мозга. Результаты. ТСТМО развился у 3 женщин в возрасте 17, 18 и 25 лет в период проведения 3-6-го курса химиотерапии, включавшего прием глюкокортикостероидов в дозе 80 мг/м2 в 1-7-й день и перорального контрацептивного средства в непрерывном режиме в течение 1,5-3 мес. Симптомами тромбоза были интенсивная головная боль, у 2 пациенток - судорожный синдром с кратковременной потерей сознания. Антикоагулянтная терапии гепарином в дозе 20-24 тыс. ЕД/сут внутривенно привела к реканализации тромба в течение 4-10 дней. При последующем наблюдении повторных тромбозов не отмечено. Заключение. Лечение молодых женщин с лимфомой Ходжкина по программе ВЕАСОРР-14, постоянно получающих пероральные контрацептивные средства, необходимо сопровождать антикоагулянтной терапией с мониторированием коагулограммы.
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