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Hyperglycemia during induction therapy for acute lymphoblastic leukemia is temporally linked to pegaspargase

Netanya I Pollock1,2, Yael Flamand3, Jia Zhu1,2

  • 1Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA.

Pediatric Blood & Cancer
|December 21, 2021
PubMed

Insights

Hyperglycemia is common in children with acute lymphoblastic leukemia (ALL) treated with chemotherapy. Older age, female sex, and family history of diabetes increase risk, necessitating frequent glucose monitoring during induction therapy.

Area of Science:

  • Pediatric Oncology
  • Endocrinology
  • Pharmacology

Background:

  • Chemotherapy regimens including glucocorticoids and pegaspargase are known to cause hyperglycemia in children with acute lymphoblastic leukemia (ALL).
  • The specific patterns and risk factors for this hyperglycemia during induction chemotherapy are not well understood.
  • This study aimed to characterize hyperglycemia and its associated factors in pediatric ALL patients receiving these agents.

Purpose of the Study:

  • To determine the pattern of hyperglycemia in children with ALL undergoing induction chemotherapy.
  • To identify demographic and clinical factors associated with hyperglycemia during this treatment phase.
  • To understand factors linked to the need for insulin treatment in these patients.

Main Methods:

  • Retrospective analysis of 213 pediatric patients treated between 2010 and 2020.
  • Data on demographics, glucose levels, and insulin regimens were collected.
  • Hyperglycemia was defined as ≥200 mg/dl on at least two occasions; logistic regression identified predictive factors.

Main Results:

  • The prevalence of hyperglycemia was 23%, with glucose levels peaking 3 days after pegaspargase administration.
  • Predictors of hyperglycemia included older age (≥10 years), female sex, and a family history of diabetes.
  • Older age, family history of diabetes, and higher BMI were associated with requiring insulin treatment.

Conclusions:

  • Hyperglycemia onset is temporally linked to pegaspargase administration in pediatric ALL induction chemotherapy.
  • Key risk factors for hyperglycemia include older age, female sex, and family history of diabetes.
  • Frequent glucose monitoring is crucial during induction therapy for ALL to manage hyperglycemia effectively.
Abstract

Keywords:
acute lymphoblastic leukemiahyperglycemiainductioninsulin

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