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Acute Pancreatitis in Pediatric Acute Lymphoblastic Leukemia (AcuPA Study): A Nationwide Survey in Poland
Anna Morawiak1, Małgorzata Salamonowicz-Bodzioch2, Aleksandra Królak1
1Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland.
Insights
Acute pancreatitis (AP) is uncommon in children with acute lymphoblastic leukemia (ALL) and linked to older age. AP does not significantly affect survival outcomes, and re-exposure to asparaginase is safe.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Research
Background:
- Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
- Asparaginase (ASP) is a key chemotherapeutic agent in ALL treatment.
- Acute pancreatitis (AP) is a known complication of ASP therapy.
Purpose of the Study:
- To determine the incidence of AP in Polish children treated for ALL.
- To identify risk factors for AP development in this cohort.
- To evaluate the impact of AP on treatment outcomes, including survival and asparaginase re-exposure.
Main Methods:
- Retrospective analysis of 2303 children receiving intensive chemotherapy for ALL.
- Division of patients into groups with and without AP.
- Statistical analysis to identify risk factors and compare survival probabilities (p-DFS, p-EFS).
Main Results:
- The cumulative incidence of AP was 4.08%.
- Older age was an independent risk factor for AP (OR = 1.05; p = 0.03).
- AP did not significantly impact disease-free survival (p-DFS) or event-free survival (p-EFS).
- Re-exposure to asparaginase in patients with a history of AP resulted in a low recurrence rate (4.5%) and did not affect survival outcomes.
Conclusions:
- AP incidence in children with ALL is low and associated with patient age.
- AP development does not negatively influence p-DFS or p-EFS in children with ALL.
- Re-exposure to asparaginase after an initial AP episode is safe and does not worsen survival outcomes.
Purpose:
This study aimed to identify the risk factors for acute pancreatitis (AP) and its impact on outcomes in Polish children treated for ALL.
Methods:
The study group included 2303 children receiving intensive chemotherapy for ALL. The group was divided into patients with at least one episode of AP and those who did not develop AP after treatment for ALL.
Results:
The cumulative incidence of AP in the study group was 4.08%. Older age was an independent risk factor for the development of AP (OR = 1.05; 95%CI = 1.006-1.098; p = 0.03). The overall mortality associated with AP was 2.13%. The probabilities of disease-free survival (p-DFS) and event-free survival (p-EFS) in both subgroups were 0.84 vs. 0.86, log-rank p = 0.65 and 0.75 vs. 0.80, log-rank p = 0.12, respectively. A total of 22 out of 94 patients (23.4%) with AP were re-exposed to asparaginase (ASP) during the subsequent treatment phases. Only one patient re-exposed to ASP (4.5%) developed a second episode of AP. There were no significant differences in p-DFS and p-EFS between patients re-exposed and not re-exposed to asparaginase (0.78 vs. 0.86, log-rank p = 0.27 and 0.63 vs. 0.79, log-rank p = 0.09, respectively).
Conclusions:
The incidence of AP in children with ALL is low and related to patients' age. The development of AP does not seem to influence p-DFS and p-EFS in children with ALL. Recurrence of AP after re-exposure to asparaginase in patients with ALL and a history of AP is low (4.5%). Re-exposure to asparaginase after the first episode of AP does not improve either p-DFS or p-EFS in children with ALL.
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Acute pancreatitis is characterized by rapid inflammation of the pancreas, often caused by factors like gallstone blockage or excessive alcohol consumption. Chronic pancreatitis, on the other hand, is a slow, progressive inflammation that may result from long-term alcohol abuse, obstructions in the pancreatic duct, or genetic factors.
The causes of acute pancreatitis include: