ABSTRACT
Objective:To analyze the risk factors for asparaginase-associated pancreatitis (AAP) in children with acute lymphoblastic leukemia (ALL) after treatment with pegaspargase and evaluate the predictive value of pediatric sequential organ failure assessment (SOFA) score, pediatric acute pancreatitis severity (PAPS) score, Ranson′s score and pediatric Ministry of Health, Labour and Welfare of Japan (JPN) score for severe AAP.Methods:Cross-sectional study.The clinical data of 328 children with ALL who received pegaspargase treatment in the Department of Pediatric Hematology, Zhujiang Hospital, Southern Medical University from January 2014 to August 2021, as well as their clinical manifestations, laboratory examinations, and imaging examinations were collected.The SOFA score at the time of AAP diagnosis, PAPS score and Ranson′s score at 48 hours after AAP diagnosis, and JPN score at 72 hours after AAP diagnosis were calculated, and their predictive value for severe AAP was evaluated by the receiver operating characteristic (ROC) curve.Results:A total of 6.7%(22/328) of children had AAP, with the median age of 6.62 years.AAP most commonly occurred in the induced remission phase (16/22, 72.7%). Three AAP children were re-exposed to asparaginase, and 2 of them developed a second AAP.Among the 22 AAP children, 16 presented with mild symptoms, and 6 with severe symptoms.The 6 children with severe AAP were all transferred to the Pediatric Intensive Care Unit (PICU). There were no significant differences in gender, white blood cell count at first diagnosis, immunophenotype, risk stratification, and single dose of pegaspargase between the AAP and non-AAP groups.The age at diagnosis of ALL in the AAP group was significantly higher than that in the non-AAP group ( t=2.385, P=0.018). The number of overweight or obese children in the AAP group was also higher than that in the non-AAP group ( χ2=4.507, P=0.034). The areas under the ROC curve of children′s JPN score, SOFA score, Ranson′s score, and PAPS score in predicting severe AAP were 0.919, 0.844, 0.731, and 0.606, respectively.The JPN score ( t=4.174, P=0.001) and the SOFA score ( t=3.181, P=0.005) showed statistically significant differences between mild and severe AAP. Conclusions:AAP is a serious complication in the treatment of ALL with combined pegaspargase and chemotherapy.Older age and overweight or obesity may be the risk factors for AAP.Pediatric JPN and SOFA scores have predictive value for severe AAP.
ABSTRACT
There is growing evidence of significant clinical and biological benefits of asparaginase (ASP) as a key agent in multidrug combination chemotherapy for pediatric acute lymphoblastic leukemia (ALL), and the drug will continue to be used at higher total doses in intermediate- and high-risk patients.However, high doses of ASP can lead to treatment-related toxicities.Among them, asparaginase-associated pancreatitis (AAP), which is a life-threatening treatment-limiting side effect of chemotherapy, will lead to interruption or complete discontinuation of ASP at grade 3 or 4 in adverse event evaluations, while interruption or discontinuation of ASP may lead to relapse in patients with ALL with an increased risk of remission failure in the case of relapse.Rapid identification and management of AAP will help ensure that patients derive maximum benefit from ASP therapy.This review summarized the diagnosis and management of AAP, possible risk factors, and prudent re-exposure to ASP after the first episode of AAP.
ABSTRACT
Asparaginase(ASP) is an important drug in the treatment of childhood acute lymphoblastic leukemia and non-Hodgkin lymphoma.Asparaginase associated pancreatitis (AAP) is the main treatment-adverse events of asparaginase.After reviewing the recent foreign literatures about AAP and the Chinese expert about polyethylene glycol conjugated asparaginase (PEG-ASP) in the treatment of acute lymphoblastic leukemia and malignant lymphoma with asparaginase,conclude and analysis the data about childhood AAP and show the epidemiology,clinical features,early diagnosis and effective treatment of children with AAP.Make clinical compare of L-asparaginase and PEG-ASP.Based on the full grasp of the relevant data,analyzing,introducing and integrating,this may be helpful to the diagnosis and treatment of childhood AAP.