Early diagnosis of asparaginase-associated pancreatitis based on elevated serum elastase-1 levels: Case reports

Area of Science:

• Oncology
• Pediatrics
• Gastroenterology

Background:

• L-asparaginase (L-asp) is a vital chemotherapeutic agent for pediatric acute lymphoblastic leukemia (ALL).
• A significant complication of L-asp therapy is asparaginase-associated pancreatitis (AAP).
• Early diagnosis of AAP is challenging with standard diagnostic markers.

Purpose of the Study:

• To highlight the utility of serum elastase-1 in the early diagnosis of asparaginase-associated pancreatitis (AAP) in pediatric ALL patients.
• To present cases where elastase-1 identified AAP before significant elevations in other pancreatic enzymes.
• To advocate for the inclusion of elastase-1 measurement in monitoring L-asp treated patients.

Main Methods:

• Case report presentation of two pediatric patients with ALL treated with L-asparaginase.
• Monitoring of serum pancreatic enzymes, including amylase, lipase, and elastase-1.
• Correlation of enzyme levels with the development of clinical symptoms suggestive of pancreatitis.

Main Results:

• Both cases demonstrated elevated serum elastase-1 levels indicative of pancreatitis.
• Serum amylase levels remained within normal limits in both patients during the early phase of pancreatitis.
• Early identification of AAP was achieved through elastase-1 measurement, facilitating prompt management.

Conclusions:

• Serum elastase-1 is a sensitive and potentially early marker for asparaginase-associated pancreatitis (AAP) in pediatric ALL.
• Routine monitoring of elastase-1 alongside amylase and lipase is recommended for L-asp-treated patients.
• Early diagnosis and intervention for AAP can improve patient outcomes and mitigate treatment-related toxicities.