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Acute pancreatitis in children with acute lymphoblastic leukemia correlates with L-asparaginase dose intensity

Chi-Bo Chen1, Hsiu-Hao Chang2, Shu-Wei Chou3

  • 1Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.

Pediatric Research
|October 31, 2021
PubMed

Insights

Asparaginase-associated pancreatitis (AAP) risk in childhood leukemia is linked to L-asparaginase dose intensity, not total dose. Identifying high-risk patients can improve treatment outcomes.

Area of Science:

  • Pediatric Oncology
  • Hematology
  • Clinical Pharmacology

Background:

  • L-Asparaginase (L-Asp) is crucial for treating childhood acute lymphoblastic leukemia (ALL).
  • Asparaginase-associated pancreatitis (AAP) is a serious L-Asp complication, often dose-related.
  • Investigating AAP incidence and risk factors in pediatric ALL patients is essential.

Purpose of the Study:

  • To determine the incidence of asparaginase-associated pancreatitis (AAP) in pediatric patients with acute lymphoblastic leukemia (ALL).
  • To identify risk factors associated with AAP development in this patient population.
  • To evaluate the relationship between L-Asp dose intensity and cumulative dose with AAP incidence.

Main Methods:

  • A retrospective study of pediatric ALL patients treated at National Taiwan University Hospital from January 2002 to December 2018.
  • Diagnosis of AAP followed the Ponte di Legno Toxicity Working Group criteria.
  • Multivariate analysis was used to identify independent predictors of AAP.

Main Results:

  • The overall incidence of AAP was 4.0% (14 out of 353 patients).
  • AAP incidence was significantly higher with the 2013 protocol (9.5%) compared to the 2002 protocol (1.3%).
  • High peak L-Asp dose intensity (>45,000 U/m²/month) and older age at diagnosis (>6.8 years) were independent risk factors for AAP.

Conclusions:

  • Pancreatitis incidence in childhood ALL correlates more strongly with L-Asp dose intensity than cumulative dose.
  • Identifying patients at high risk for pancreatitis can facilitate early diagnosis and complication reduction.
  • These findings can inform new protocols to minimize treatment-related complications and improve ALL outcomes.
Abstract

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