Hypertriglyceridemia During Anticancer Therapy in Pediatric Patients with Acute Lymphoblastic Leukemia - A Nationwide...

In this study, we aimed to assess the demographics and incidence of hypertriglyceridemia (HTG) during acute lymphoblastic leukemia (ALL) treatment, complications related to HTG, and the treatment strategies applied in pediatric patients treated in pediatric hemato-oncology centers in Poland.

A total of 72 out of 641 children, aged <18 years with ALL were diagnosed with HTG as a treatment-related complication. Statistical analyses were conducted with a significance level of α = 0.05.

The emergence of HTG is a significant complication, with median peak triglyceride levels during treatment reaching 1385.00 mg/dL. Only 5.56% (n = 4) experienced complications. No patients developed pancreatitis. Treatment interruptions were minimal (a median 5.67 days). No children died due to HTG. Management strategies for HTG management included plasmapheresis in 8.3% (n = 6/72). Other therapies - insulin (23.6%, n = 17), heparin (34.7%, n = 25), fibrates (41.7%, n = 30), and omega-3 fatty acids (58.3%, n = 45). A correlation was observed between low antithrombin levels and high TG levels.

This is the first nationwide, multicenter analysis conducted across pediatric hemato-oncology centers in Poland evaluating HTG during ALL therapy. HTG occurred in 11.1% of children in the analyzed cohort, and 72% of these cases were grade 3 or 4. With the management strategies applied, severe complications were uncommon and chemotherapy interruptions were generally short. Our findings support the effective triglyceride monitoring; however, triglyceride measurements are currently not standardized and are not performed at predefined time points during treatment. The observed association between low antithrombin levels and high triglyceride concentrations may help identify patients who require closer surveillance. Further prospective studies are needed to define risk factors, optimize prevention and treatment strategies and explore long-term outcomes.