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Insulin infusion to treat severe hypertriglyceridemia associated with pegaspargase therapy: a case report

Eileen B Lawson1, Michael Gottschalk, Deborah E Schiff

  • 1UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, San Diego, CA, USA. ebrigid@ucsd.edu

Journal of Pediatric Hematology/Oncology
|February 24, 2011
PubMed

Insights

Pegaspargase therapy for acute leukemia can cause severe hypertriglyceridemia (hyperTG). Continuous insulin infusion effectively managed this metabolic complication in a pediatric patient, highlighting the role of apolipoprotein E genetics.

Area of Science:

  • Biochemistry
  • Pediatric Oncology
  • Pharmacology

Background:

  • Pegaspargase is a crucial chemotherapeutic agent for acute lymphoblastic leukemia (ALL).
  • Asparaginase therapy can lead to metabolic complications, including hypertriglyceridemia (hyperTG).
  • Understanding these adverse events is vital for patient management.

Observation:

  • A pediatric patient with acute leukemia developed severe hyperTG during pegaspargase treatment.
  • The patient's triglyceride levels were critically high upon admission.
  • Genetic testing identified the patient as an apolipoprotein E (ApoE) 3/4 heterozygote.

Findings:

  • Continuous insulin infusion therapy was administered to manage the severe hyperTG.
  • This treatment significantly reduced triglyceride levels from 4640 mg/dL to 522 mg/dL within 9 days.
  • ApoE polymorphism may be a risk factor for developing asparaginase-induced hyperTG.

Implications:

  • Continuous insulin infusion is a viable treatment for pegaspargase-induced hyperTG.
  • ApoE genotyping may help identify patients at high risk for this metabolic complication.
  • This case highlights the importance of monitoring metabolic parameters during asparaginase therapy in pediatric ALL patients.

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