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Updated: Jan 18, 2026
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Published on: November 21, 2018
Nutritional status as a risk factor for adverse events associated with L-Asparaginase in children with acute
Jesús Alonso Gándara-Mireles1,2, Verónica Loera Castañeda1,2, Ismael Lares-Assef1,2
1Genomics Academy, National Polytechnic Institute, CIIDIR-Durango Unit, Durango, Mexico.
Insights
Protein-energy malnutrition (PEM) significantly increases the risk of adverse events (AEs) from L-asparaginase (L-Asp) in children with acute lymphoblastic leukemia (ALL). Addressing PEM may improve treatment safety.
Area of Science:
- Pediatric Oncology
- Clinical Nutrition
- Pharmacology
Background:
- Acute lymphoblastic leukemia (ALL) treatment commonly uses asparaginase (ASNase).
- The *Escherichia coli*-derived formulation (L-Asp) is associated with adverse events (AEs) like pancreatitis and hypersensitivity.
- Nutritional status may influence L-Asp toxicity.
Purpose of the Study:
- To investigate the link between protein-energy malnutrition (PEM) and L-Asp-induced AEs in pediatric ALL patients.
Main Methods:
- Prospective observational cohort study with nested case-control analysis.
- 91 pediatric patients treated with L-Asp were assessed.
- Methods included anthropometry, anti-L-Asp antibody testing, and AE monitoring.
Main Results:
- 19.8% of patients experienced AEs (pancreatitis, hypersensitivity).
- PEM was present in 77.7% of patients with AEs and significantly associated with AEs (OR=12.22, p=0.02).
- Pancreatitis was linked to PEM during induction; hypersensitivity reactions were associated with anti-L-Asp antibodies and PEM during reinduction.
Conclusions:
- Protein-energy malnutrition (PEM) is a significant risk factor for L-Asp toxicity in pediatric ALL.
- Nutritional status is a modifiable factor for improving L-Asp safety.
- Early detection and management of PEM could enhance L-Asp therapy outcomes.
Background:
Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer, and asparaginase (ASNase) is a key component of its treatment. However, ASNase is frequently associated with adverse events (AEs), such as pancreatitis and hypersensitivity reactions particularly with the Escherichia coli derived formulation (L-Asp) which may be influenced by nutritional status.
Objective:
To evaluate the association between protein-energy malnutrition (PEM) and the incidence of L-Asp induced AEs in children with ALL.
Methods:
A prospective observational cohort with a nested case-control comparative analysis was conducted in 91 pediatric patients treated with L-Asp. Anthropometric measurements, anti-L-Asp antibody detection, and AEs occurrence were assessed.
Results:
Eighteen patients (19.8%) developed AEs: six pancreatitis and 12 hypersensitivity reactions. Of these, 14 (77.7%) had PEM. PEM was significantly associated with AEs (OR = 12.22; p = 0.02). Pancreatitis occurred mostly during induction and affected 83.3% of PEM patients. Hypersensitivity reactions were more frequent during reinduction and were associated with anti-L-Asp antibodies in all cases, 75% of which had PEM.
Conclusions:
PEM was significantly linked to increased risk of L-Asp related toxicity, suggesting nutritional status as a modifiable factor. Early identification and correction of PEM may improve the safety profile of L-Asp in pediatric ALL therapy.
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