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Published on: July 20, 2016
Glucose metabolism in children with acute lymphoblastic leukemia treated according to two different L-asparaginase
Insights
Children with acute lymphoblastic leukemia (ALL) may develop impaired glucose tolerance (IGT) due to the leukemia itself, not just treatment. Further research is needed to understand these metabolic changes in pediatric cancer patients.
Area of Science:
- Pediatric Oncology
- Endocrinology
- Hematology
Background:
- Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
- Cancer treatments and the disease itself can impact carbohydrate metabolism.
- Understanding glucose and insulin dynamics in ALL patients is crucial for managing long-term health.
Purpose of the Study:
- To investigate the incidence and characteristics of impaired glucose tolerance (IGT) in children undergoing treatment for acute lymphoblastic leukemia (ALL).
- To assess the impact of L-asparaginase and steroid therapy on glucose and insulin levels in pediatric ALL patients.
- To explore the potential role of the leukemic process versus treatment in causing metabolic abnormalities.
Main Methods:
- Oral glucose tolerance tests (OGTT) were conducted on 47 children with ALL.
- Glucose and insulin levels were measured before and after L-asparaginase (L-asp) administration.
- Patients were categorized into two groups based on the timing of L-asp therapy (consolidation vs. induction) and concomitant medications (vincristine, prednisone).
Main Results:
- In children receiving L-asp as consolidation, 13% developed transient IGT post-therapy.
- In children receiving L-asp during induction, 23% had pre-existing IGT, with some progressing to diabetes mellitus post-therapy.
- IGT in ALL patients was often associated with normal insulin levels, suggesting the leukemia itself may be a primary factor.
- Concomitant steroid use did not significantly influence IGT incidence in this series.
Conclusions:
- Impaired glucose tolerance in children with ALL may be intrinsically linked to the leukemic process rather than solely treatment-related.
- The presence of IGT before therapy could be a marker related to the leukemia itself.
- Further investigation into the mechanisms of carbohydrate metabolism abnormalities in pediatric ALL is warranted.
Abstract:
Oral glucose tolerance tests were performed in 47 children with acute lymphoblastic leukemia (ALL), treated according to 2 consecutive protocols. Glucose and insulin values were assessed before and after L-asparaginase (L-asp). 30 children (group A) received L-asp as a single-agent consolidation course, after achieving remission with vincristine (VCR) and prednisone (PDN). Normal insulin and glucose levels were found in all patients before L-asp; 4 children (13%) had a transient impaired glucose tolerance (IGT) after completing L-asp therapy. 17 children (group B) were given L-asp during induction therapy with VCR and PDN, and all achieved complete remission. 5 patients (23%) had IGT, without hypoinsulinemia, before L-asp administration. IGT normalized in 4 patients after L-asp, the other children developed a diabetes mellitus. Only 1 patient, with a normal IGT test before L-asp therapy, showed a transient IGT after L-asp. In patients with ALL, the presence of IGT before treatment may be related to leukemia. The concomitant use of steroids does not influence the incidence of IGT in our series. Our data reveal normal insulinemia in patients with IGT. Thus, the leukemic process itself may play a much more significant role in inducing abnormalities in carbohydrate metabolism.
