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Incidence of PEG-Asparaginase-Induced Pancreatitis in Children During Acute Lymphoblastic Leukemia Treatment: A

Hanan M Alrasheedi1, Farah Malaeb1, Sameh Awwad2

  • 1Pediatric Hematology and Oncology, King Fahad Medical City, Riyadh, SAU.

Cureus
|September 2, 2025
PubMed

Insights

Pediatric acute lymphoblastic leukemia (ALL) patients treated with PEG-asparaginase (PEG-ASPA) in Saudi Arabia experienced a 5% incidence of acute pancreatitis (AP). Older age and intensive treatment protocols were linked to higher AP risk.

Area of Science:

  • Pediatric Oncology
  • Hematology
  • Clinical Pharmacology

Background:

  • Acute lymphoblastic leukemia (ALL) is a leading pediatric cancer worldwide.
  • PEG-asparaginase (PEG-ASPA) is vital for ALL treatment but can cause acute pancreatitis (AP).
  • This study investigates PEG-ASPA-induced AP in Saudi pediatric ALL patients.

Purpose of the Study:

  • To determine the incidence of PEG-ASPA-induced AP in pediatric ALL patients in Saudi Arabia.
  • To identify risk factors associated with PEG-ASPA-induced AP.
  • To inform clinical practice for managing PEG-ASPA toxicity.

Main Methods:

  • A multicenter retrospective cohort study of 322 pediatric ALL patients.
  • Data collected from January 2019 to October 2023 across three Saudi tertiary centers.
  • Multivariate logistic regression analyzed risk factors for AP, defined by CTCAE v5.0 criteria.

Main Results:

  • The incidence of PEG-ASPA-induced AP was 5% (16/322 patients).
  • AP was more common in patients over 10 years old and during specific treatment phases (consolidation, interim maintenance 2).
  • Risk factors included age >10 years (OR=3.65), high-risk protocols (OR=2.07), and >5 PEG-ASPA doses (OR=1.58).

Conclusions:

  • The incidence of PEG-ASPA-induced AP in Saudi Arabia aligns with global data.
  • Increased age, intensive protocols, and cumulative PEG-ASPA dosing are potential risk factors.
  • Monitoring pancreatic enzymes and triglycerides is recommended for early detection and risk reduction.
Abstract

Keywords:
allasparaginasepancreatitispediatrictreatment

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