Related Experiment Videos
Fasting hypoglycemia is common during maintenance therapy for childhood acute lymphoblastic leukemia
P Halonen1, M K Salo, A Mäkipernaa
1Department of Pediatrics, Tampere University Hospital, Tampere, Finland.
Insights
Children with acute lymphoblastic leukemia on maintenance therapy experienced hypoglycemia. Fasting tolerance improved significantly after stopping 6-mercaptopurine and methotrexate treatment.
Area of Science:
- Pediatric Oncology
- Endocrinology
- Pharmacology
Background:
- Acute lymphoblastic leukemia (ALL) is the most common childhood cancer.
- Maintenance therapy for ALL often involves 6-mercaptopurine (6-MP) and methotrexate (MTX).
- Hypoglycemia is a potential adverse effect of certain cancer chemotherapies.
Purpose of the Study:
- To investigate the incidence of hypoglycemia in children with ALL undergoing maintenance therapy.
- To assess the impact of 6-MP and MTX on fasting glucose levels.
- To evaluate the reversibility of hypoglycemia after treatment cessation.
Main Methods:
- Prospective observation of 35 children with ALL on maintenance therapy.
- Monitoring blood glucose levels during a 16-hour overnight fast.
- Re-evaluation of fasting tolerance in a subset of children after discontinuing therapy.
Main Results:
- 54% (19/35) of children developed hypoglycemia (blood glucose <2.7 mmol/L or <2.9 mmol/L with symptoms).
- In 15 re-studied children, fasting tolerance improved after cessation of 6-MP and MTX.
- 67% (10/15) of re-studied children achieved normal fasting tolerance within months.
Conclusions:
- Maintenance therapy with 6-mercaptopurine and methotrexate is associated with a high incidence of hypoglycemia in children with ALL.
- Hypoglycemia induced by this therapy is often reversible upon treatment discontinuation.
- Further research is warranted to understand the mechanisms and long-term implications.
Abstract:
Nineteen of 35 children (54%) with acute lymphoblastic leukemia receiving maintenance therapy consisting of daily oral 6-mercaptopurine and weekly oral methotrexate developed hypoglycemia (blood glucose level <2.7 mmol/L [50 mg/dL] or <2.9 mmol/L [54 mg/dL] with symptoms) during 16 hours of overnight fasting. In 15 of 15 re-studied children, fasting tolerance had improved, and in 67% (10/15), it had become normal a few months after cessation of therapy.