Diabetic ketoacidosis during therapy for pediatric acute lymphoblastic leukemia.

BACKGROUND: Hyperglycemia is common during therapy for acute lymphoblastic leukemia (ALL), but diabetic ketoacidosis (DKA) occurs rarely. Morbidity due to DKA in children with ALL has not been systematically studied. PROCEDURES: We reviewed risk factors and clinical consequences of DKA in patients undergoing therapy for ALL at SJCRH between 1991 and 2006. RESULTS: DKA occurred in 6 of 797 evaluable patients. Only older age at diagnosis of ALL was a risk factor for DKA. Four of six patients with DKA as compared to 232 of the other 791 patients were older than 10 years (P = 0.03). Race, sex, body mass index, leukemia immunophenotype, ALL risk category, white blood cell count at diagnosis, and treatment protocol were not associated with DKA. All patients were managed with intravenous fluids, dietary modification, and short-term use of insulin. Patients were hospitalized for 4-12 days, with a median ICU stay of 1 day. In two patients, correction of hyperglycemia was too rapid, and two others experienced hypoglycemia due to insulin therapy. There were no permanent complications of DKA or its treatment. No patient required long-term insulin use. No patient had recurrent DKA; only one of the six patients had a subsequent hyperglycemia episode. All six patients are alive in remission 6-13 years after diagnosis. CONCLUSIONS: Patients with hyperglycemia during treatment for ALL should be screened for clinical evidence of DKA, which may require more intensive supportive care than those without ketoacidosis. The occurrence of DKA should not lead to alteration of ALL treatment.

Prognostic significance of myeloperoxidase expression in childhood acute myeloid leukemia.

BACKGROUND: The percentage of myeloperoxidase (MPO)-positive blast cells is associated with prognosis in adult acute myeloid leukemia (AML), but this association is unsubstantiated in pediatric AML. PROCEDURE: We retrospectively compared cytochemical MPO results with outcome in 154 patients younger than 21 years treated on three consecutive institutional protocols for newly diagnosed AML (1987-2001). Patients with FAB M0 and M7 AML (no MPO expression) or M3 AML (100% MPO expression) and Down's syndrome were excluded. RESULTS: Median MPO expression was higher in FAB M2 subtype than in other subtypes (P < 0.0001) and differed significantly across cytogenetic risk groups (P = 0.002) with highest MPO expression among those with favorable karyotypes. The percentage of MPO-positive blasts was not significantly associated with the probability of complete remission (P = 0.97), event-free survival (P = 0.72), or survival (P = 0.76) in multivariate analyses that accounted for age, FAB subtype, presenting WBC count, cytogenetic and protocol treatment risk group. In analysis limited to patients with intermediate-risk cytogenetics, higher MPO expression appeared to be associated with improved EFS (P = 0.06) but was not associated with remission induction rate (P = 0.16) or overall survival (P = 0.38). CONCLUSIONS: The percentage of MPO-positive blast cells is related to FAB subtype in pediatric AML but has limited prognostic relevance.