[Transient diabetes mellitus related to L-asparaginase therapy]

Treatment of hematological malignancies with L-asparaginase has been associated with diabetes mellitus in about 1-2% of patients. The concomitant use of steroids has an additional deleterious effect. In this article, we report the occurrence of diabetes in a 13 year-old girl treated with L-asparaginase and dexamethasone for acute lymphoblastic leukemia. The diabetes developed 120 days after the drug was started, requiring insulin therapy for 12 months. Anti-islet autoantibody was negative, and there were no laboratory findings suggestive of pancreatitis. The DM related do L-asparaginase therapy is insulinopenic and transient, resolving with suspension of the drug. The diagnosis of this type of diabetes is based on its temporal relationship with the L-asparaginase and in the exclusion of other known causes. There is no laboratory test capable of elucidating the diagnosis. Therefore, investigation to rule out type 1A DM, type 1B DM, insulin-resistant DM induced by corticotherapy and DM secondary to toxic pancreatitis is of utmost importance. The insulin therapy must be followed closely, since this is a transient form of diabetes.