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When and why do children develop hyperglycemia during acute lymphoblastic leukemia therapy?

Lívia Cristina Oliveira E Silva1, Adriana Aparecida Siviero-Miachon1,2, Ana Virgínia Lopes Sousa2

  • 1Universidade Federal de São Paulo, Escola Paulista de Medicina, Division of Pediatric Endocrinology - São Paulo (SP), Brazil.

Revista Da Associacao Medica Brasileira (1992)
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Hyperglycemia is common in children with acute lymphoblastic leukemia (ALL) during chemotherapy, especially in pubertal patients. However, this common side effect did not worsen their outcomes, including infections or mortality.

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Area of Science:

  • Pediatric Oncology
  • Endocrinology
  • Hematology

Background:

  • Hyperglycemia is a known complication during cancer treatment.
  • Understanding its risk factors and impact is crucial for pediatric acute lymphoblastic leukemia (ALL) management.

Purpose of the Study:

  • To identify risk factors for hyperglycemia in pediatric ALL patients undergoing chemotherapy.
  • To evaluate the impact of hyperglycemia on treatment outcomes.

Main Methods:

  • Retrospective cohort study of 188 pediatric ALL patients (2004-2017).
  • Hyperglycemia assessed during induction and consolidation chemotherapy phases.
  • Multivariate analysis examined associations with patient/disease characteristics and outcomes (infections, relapse, mortality).

Main Results:

  • Hyperglycemia occurred in 43.6% of patients, mainly during induction.
  • Pubertal status, younger age, and high relapse risk were associated with increased hyperglycemia risk (puberty: ~8-fold risk).
  • Hyperglycemia was not linked to increased infections, relapse, or mortality; however, overweight/obesity and pancreatitis/recurrent infections correlated with higher mortality.

Conclusions:

  • Hyperglycemia is a frequent early adverse event in pediatric ALL treatment, particularly in pubertal and high-risk patients.
  • Despite high incidence, hyperglycemia did not negatively impact clinical outcomes in this cohort.
  • Early identification and monitoring of hyperglycemia are important during intensive treatment phases.