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Acute pancreatitis in children with acute lymphoblastic leukemia after chemotherapy
Suporn Treepongkaruna1, Naporn Thongpak, Samart Pakakasama
1Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. rastp@mahidol.ac.th
Insights
Acute pancreatitis (AP) is a serious complication for children with acute lymphoblastic leukemia (ALL). High-risk chemotherapy regimens increase the risk of AP, which is associated with higher mortality rates in ALL patients.
Area of Science:
- Pediatric Oncology
- Gastroenterology
- Hematology
Background:
- Acute pancreatitis (AP) is a known complication in pediatric patients undergoing chemotherapy for acute lymphoblastic leukemia (ALL).
- L-asparaginase (L-asp) therapy is frequently associated with the development of AP in this vulnerable population.
Purpose of the Study:
- To investigate the incidence, risk factors, clinical characteristics, outcomes, and mortality associated with AP in children diagnosed with ALL.
- To identify specific risk factors contributing to AP development in pediatric ALL patients.
Main Methods:
- A retrospective cohort study analyzed data from 192 pediatric ALL patients treated between 2000 and 2006.
- A nested case-control study identified risk factors for AP by comparing patients with AP (cases) to those without (controls).
Main Results:
- The overall incidence of AP was 8.3%, with L-asp-associated AP occurring in 7.3% of patients.
- AP onset occurred after a median of 5.5 L-asp doses, with a median of 4 days between the last L-asp dose and AP onset.
- Mortality was significantly higher in the AP group (43.8%) compared to the non-AP group (19.3%), with systemic infection and underlying disease complications being contributing factors. High-risk chemotherapy regimens were identified as the sole risk factor for AP.
Conclusions:
- High-risk chemotherapy regimens are a significant risk factor for developing pancreatitis in children with ALL.
- Pediatric ALL patients who develop AP face a considerably higher mortality rate compared to those who do not experience pancreatitis.
Background:
Acute pancreatitis (AP) is a complication in children with acute lymphoblastic leukemia (ALL) receiving chemotherapy and has often been reported associated with L-asparaginase (L-asp) therapy.
Objectives:
To determine the incidence, risk factors, clinical data, outcome, and mortality of AP in children with ALL.
Methods:
Retrospective cohort study was conducted by reviewing the data of total 192 pediatric ALL patients from Pediatric Oncology Registry at Ramathibodi Hospital from 2000 to 2006 to assess incidence, clinical data, outcome, and mortality of AP. Then, a nested case-control study was conducted to identify potential risk factors for AP by recruiting all patients with AP as cases (n=16), and randomly selected patients without AP to serve as controls up to approximately four controls per case with the total of 68 controls.
Results:
The total incidence of AP in children with ALL and L-asp-associated AP was 8.3% and 7.3%, respectively. In patients with L-asp-associated AP, pancreatitis developed after the median 5.5 doses (range: 1 to 20 doses) of L-asp therapy and the median interval from the last dose of L-asp to the onset of AP was 4 days (range: 1 to 13 days). The mortality rate of AP group was significantly higher than the patients without AP (43.8% vs. 19.3%, P=0.02). Mortality was associated with concurrent systemic infection and complications of underlying diseases. Multivariate analysis identified using a high-risk chemotherapy regimen was the only risk factor for AP.
Conclusions:
Using a high-risk chemotherapy regimen was a risk factor for pancreatitis in patients with ALL. ALL children with AP had higher mortality rate than those without pancreatitis.
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