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Conservative management of pancreatic pseudocysts in children with acute lymphoblastic leukemia

Holly L Spraker1, Georgios P Spyridis, Ching-Hon Pui

  • 1Department of Oncology, St Jude Children's Research Hospital, Memphis, TN 38105, USA. holly.spraker@stjude.org

Journal of Pediatric Hematology/Oncology
|December 4, 2009
PubMed

Insights

Asparaginase treatment for acute lymphoblastic leukemia can lead to pancreatitis and pseudocysts. Nonsurgical management is safe for these pediatric patients, allowing chemotherapy continuation and eventual oral feeding.

Area of Science:

  • Pediatric Oncology
  • Gastroenterology
  • Hematology

Background:

  • Asparaginase is a critical chemotherapeutic agent for acute lymphoblastic leukemia (ALL).
  • Asparaginase therapy is associated with a risk of developing acute pancreatitis.
  • Pancreatitis complications, such as pancreatic pseudocysts, can significantly impact patient management.

Observation:

  • This report details five pediatric patients with ALL who developed acute pancreatitis with pseudocyst formation during asparaginase treatment.
  • These patients required adjustments to their chemotherapy schedules and extended parenteral nutrition.
  • No surgical interventions were necessary for the management of the pancreatic pseudocysts.

Findings:

  • All five patients achieved first remission and survived.
  • Pancreatic pseudocysts resolved spontaneously over 3 to 37 months or showed continued size reduction.
  • Oral feeding was successfully reintroduced after the acute pancreatitis resolved, even with persistent pseudocysts.

Implications:

  • Nonsurgical management of pancreatic pseudocysts in pediatric ALL patients is a safe and effective approach.
  • Pseudocyst resolution can be a lengthy process, requiring patience and monitoring.
  • Early reintroduction of oral feeding is feasible and beneficial for patients recovering from pancreatitis-induced pseudocysts.

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