Clinical characteristics of children with acute lymphoblastic leukemia presenting with secondary acute pancreatitis
10.3969/j.issn.1000-8179.2020.13.314
- VernacularTitle: 儿童急性淋巴细胞白血病并发急性胰腺炎的临床特点分析
- Author:
Hui CHEN
1
Author Information
1. Department of Hematology, Tianjin Children's Hospital
- Publication Type:Journal Article
- Keywords:
Acute lymphoblastic leukemia (ALL);
Asparaginase;
Children;
Pancreatitis;
Polyethylene glycol conjugated asparaginase (PEG-ASP)
- From:
Chinese Journal of Clinical Oncology
2020;47(13):666-669
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To analyze the clinical characteristics of children with acute lymphoblastic leukemia (ALL) diagnosed with secondary acute pancreatitis(AP). Methods: We collected data from a total of 11 patients with ALL and secondary acute pancreatitis who were treated in Tianjin Children's Hospital from February 2013 to February 2020. All patients followed the China Children's Leukemia Collaborative Group-Acute Lymphocytic Leukemia-2008 (CCLG- ALL 2008) combined regimen. We summarized the patient's risk stratification, primary clinical manifestations, treatment stage, cause of pancreatitis, and cumulative dosage of polyethylene glycol conjugated asparaginase (PEG-ASP). The results from examinations such as pancreatic enzyme index, imaging, blood routine, liver and kidney function, blood lipid and blood glucose, and coagulation function were also compared. Finally, the therapeutic effects and outcomes of the patients were compared; and subsequently their clinical characteristics were analyzed. Results: Among the 11 patients 7 were male, and 4 were female; aged between 1-14 years old, with a median age of 6 years. Ten patients had type B acute lymphoblastic leukemia (B-ALL) and 1 had type T acute lymphoblastic leukemia (T-ALL). Pancreatitis was observed in 8 cases within 45 days after start of therapy, in one high-risk case after the second cycle of HR3' chemotherapy and in 2 cases after intensive chemotherapy. It was observed in 10 cases after PEG-ASP treatment, and in one T-ALL case concomitant with tumor lysis syndrome following cyclophosphamide-dexamethasone cytoduction treatment. It manifested primarily as abdominal pain, nausea and vomiting in 11 patients; 8 patients had hypocalcemia; 9 patients had low albumin levels; and 8 patients had abnormal coagulation function. No hypersensitivity was observed. Conclusions: Secondary AP occurs in children with ALL during the early stages of combined chemotherapy. Most of the complications are related to the asparaginase treatment. The severity of the disease is not significantly correlated with the risk stratification of the disease and the cumulative dose of asparaginase. Serum pancreatic enzyme (PE) testing and imaging tests can help assess the clinical status and guide the later prognosis and medication.
