Contributions
Abstract: PB1372
Type: Publication Only
Session title: Acute lymphoblastic leukemia - Clinical
Background
L-asparaginase (L-ASP) is one of the most important chemotherapy drugs in the treatment of acute lymphoblastic leukemia (ALL). This drug, which has a crucial role in the treatment of ALL induction, has many toxicities like hypersensitivity reactions, pancreatitis, hemostatic disorders, liver function test disorders, and hyperlipidemia. L-ASP-associated pancreatitis is a serious condition with a frequency of 2-10%, with significant morbidity and sometimes death.
Aims
In this study, we aimed to describe the clinical findings and complications of L-ASP-associated acute pancreatitis in children with ALL and also to examine the attitude of the centers in terms of re-administration of L- ASP after development of pancreatitis.
Methods
Patient data form sent to pediatric hematology/oncology clinics with the announcement of Turkish Pediatric Hematology Society for retrospective evaluation of ALL cases with L-ASP associated acute pancreatitis. All patients were treated with ALLIC or BFM based ALL protocols.
Results
Thirty-one ALL patients from 10 centers, who were diagnosed with L-ASP-associated acute pancreatitis between September 2008 and January 2020 were included in the study. The median follow-up time was 59 months (8-139 months). There was a total of 34 acute pancreatitis episodes due to recurrences in two patients. The median age was 70 months (21-213 months) and male to female ratio was 0.9. Twenty-four patients (77%) were newly diagnosed ALL patients and 7 patients (22%) were relapse patients. Of the 24 newly diagnosed ALL patients; 7 patients (29%) were in the standard risk group, 8 patients (33%) were in the medium-risk group, and the remaining 9 patients (38%) were in the high-risk group. Acute pancreatitis occurred during treatment phase of induction in 9 (26%) patients, consolidation in 6 (18%), re-induction in 9 (26%), maintenance in 3 (9%) and relapse in 7 (21%) patients. E. Coli L-asparaginase was the most frequently used (74%) preparation. The most common complaint was abdominal pain (96%); followed by anorexia (68%), nausea/vomiting (56%) and high fever (39%). The median time between the last dose of L-ASP and the diagnosis of acute pancreatitis was 6 days (1-18 days). The median duration of treatment interruption was 16 days (0-240 days). Complications of pancreatitis was death in 3 patients (9.6%), insulin dependent diabetes in 6 patients (19.3%), and pancreatic pseudocyst in 6 patients (19.3%). L-ASP was completely removed from the protocol in 23 patients (74%) after the incidence of acute pancreatitis while it was re-administered in 6 patients (19%). Pancreatitits recurred in 2 (33%) of those 6 patients but none of the repeated episodes resulted in death.
Conclusion
This retrospective study demonstrated a relatively high complication rate due to L-ASP associated acute pancreatitis. Most centers showed a tendency to permanently discontinue L-ASP treatment after the incidence of pancreatitis. Re-exposure to L-ASP resulted with recurrence in some of the patients. Although there are serious complications resulting in death after L-ASP-associated pancreatitis, it has already been known that event-free survival is negatively affected in patients who can not receive scheduled L-ASP doses. For this reason, large-scaled comprehensive studies are needed to determine the criteria for re-administration of the drug and also to make changes in the general protocol approach when necessary.
Keyword(s): L-asparaginase, Leukemia, Pancreas, Side effects
Abstract: PB1372
Type: Publication Only
Session title: Acute lymphoblastic leukemia - Clinical
Background
L-asparaginase (L-ASP) is one of the most important chemotherapy drugs in the treatment of acute lymphoblastic leukemia (ALL). This drug, which has a crucial role in the treatment of ALL induction, has many toxicities like hypersensitivity reactions, pancreatitis, hemostatic disorders, liver function test disorders, and hyperlipidemia. L-ASP-associated pancreatitis is a serious condition with a frequency of 2-10%, with significant morbidity and sometimes death.
Aims
In this study, we aimed to describe the clinical findings and complications of L-ASP-associated acute pancreatitis in children with ALL and also to examine the attitude of the centers in terms of re-administration of L- ASP after development of pancreatitis.
Methods
Patient data form sent to pediatric hematology/oncology clinics with the announcement of Turkish Pediatric Hematology Society for retrospective evaluation of ALL cases with L-ASP associated acute pancreatitis. All patients were treated with ALLIC or BFM based ALL protocols.
Results
Thirty-one ALL patients from 10 centers, who were diagnosed with L-ASP-associated acute pancreatitis between September 2008 and January 2020 were included in the study. The median follow-up time was 59 months (8-139 months). There was a total of 34 acute pancreatitis episodes due to recurrences in two patients. The median age was 70 months (21-213 months) and male to female ratio was 0.9. Twenty-four patients (77%) were newly diagnosed ALL patients and 7 patients (22%) were relapse patients. Of the 24 newly diagnosed ALL patients; 7 patients (29%) were in the standard risk group, 8 patients (33%) were in the medium-risk group, and the remaining 9 patients (38%) were in the high-risk group. Acute pancreatitis occurred during treatment phase of induction in 9 (26%) patients, consolidation in 6 (18%), re-induction in 9 (26%), maintenance in 3 (9%) and relapse in 7 (21%) patients. E. Coli L-asparaginase was the most frequently used (74%) preparation. The most common complaint was abdominal pain (96%); followed by anorexia (68%), nausea/vomiting (56%) and high fever (39%). The median time between the last dose of L-ASP and the diagnosis of acute pancreatitis was 6 days (1-18 days). The median duration of treatment interruption was 16 days (0-240 days). Complications of pancreatitis was death in 3 patients (9.6%), insulin dependent diabetes in 6 patients (19.3%), and pancreatic pseudocyst in 6 patients (19.3%). L-ASP was completely removed from the protocol in 23 patients (74%) after the incidence of acute pancreatitis while it was re-administered in 6 patients (19%). Pancreatitits recurred in 2 (33%) of those 6 patients but none of the repeated episodes resulted in death.
Conclusion
This retrospective study demonstrated a relatively high complication rate due to L-ASP associated acute pancreatitis. Most centers showed a tendency to permanently discontinue L-ASP treatment after the incidence of pancreatitis. Re-exposure to L-ASP resulted with recurrence in some of the patients. Although there are serious complications resulting in death after L-ASP-associated pancreatitis, it has already been known that event-free survival is negatively affected in patients who can not receive scheduled L-ASP doses. For this reason, large-scaled comprehensive studies are needed to determine the criteria for re-administration of the drug and also to make changes in the general protocol approach when necessary.
Keyword(s): L-asparaginase, Leukemia, Pancreas, Side effects