Risk Factors for Hyperglycemia in Children with Leukemia Receiving L-asparaginase

ABSTRACT

Hyperglycemia is a well-recognized side effect of L-asparaginase in remission induction therapy of acute lymphocytic leukemia. Since hyperglycemia has preceded fatal diabetic ketoacidosis or hyperosmotic nonketotic coma in some patients, early detection and treatment of this complication are important. We determined retrospectively the risk of hyperglycemia in 117 patients with leukemia who had received L-asparaginase (& prednisolone). The results were as follows 1) Twenty (17%) of the 117 patients developed hyperglycemia. 2) Of 47 female patients, 13 developed hyperglycemia, contrast with only 7 of 70 male patients(P<0.05). 3) All 2 obese patients developed hyperglycemia, contrast with 18 of 115 non obese patients (P<0.05). 4) Of 16 patients with a history of previous administration of L-asparaginase 6 (42%) developed hyperglycemia, contrast with only 14 (11%) of the remaining 101 patients (P<0.05). 5) Of the remaining factors analyzed-age, leukocyte counts, family history, dose of L-asparaginase-non had a statistically important influence on the development of hyperglycemia. 6) The mean glucose concentration at onset was 355+/-197.5mg/dl in patient who developed hyperglycemia with peak concentration of 404+/-253.6mg/dl. Hyperglycemia developed between 3 to 20 days after administration of L-asparaginase, and the duration of hyperglycemia was 6.90+/-5.54 days. Since hyperglycemia developed inevitably in a certain proportion of patients given L-asparaginase, we recommend blood glucose monitoring in patients with the risk factors.