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Multicenter Study
. 2009 Aug;53(2):162-7.
doi: 10.1002/pbc.22076.

Clinical course and outcome in children with acute lymphoblastic leukemia and asparaginase-associated pancreatitis

Susan L Kearney  1 , Suzanne E Dahlberg, Donna E Levy, Stephan D Voss, Stephen E Sallan, Lewis B Silverman
Affiliations
Multicenter Study

Clinical course and outcome in children with acute lymphoblastic leukemia and asparaginase-associated pancreatitis

Susan L Kearney et al. Pediatr Blood Cancer. 2009 Aug.

Abstract

Background: Asparaginase, an agent used in the treatment of acute lymphoblastic leukemia (ALL), is associated with the development of pancreatitis. The clinical course and long-term outcome of patients experiencing this complication has not been extensively detailed.

Procedure: We reviewed the clinical course for all children with ALL diagnosed with pancreatitis at the Dana-Farber Cancer Institute/Children's Hospital Boston between 1987 and 2003. The outcome of these patients was compared with that of patients with ALL who did not experience pancreatitis.

Results: Twenty-eight of 403 children (7%) were diagnosed with pancreatitis. Patients 10-18 years old at diagnosis had 2.4 times the risk of developing pancreatitis compared with younger patients. Pancreatitis typically occurred early in the course of therapy (median 4 weeks after first dose of asparaginase). Ninety-three percent of affected patients were hospitalized and 57% received parenteral nutrition. No patient developed chronic sequelae or died as a result of pancreatitis. Sixteen (57%) patients were re-treated with asparaginase, 10 of whom had another episode of pancreatitis. No significant differences in event-free survival were observed when comparing patients with and without a history of pancreatitis.

Conclusion: Asparaginase-associated pancreatitis was more common in older children, and caused significant acute morbidity. It tended to occur after the first few doses of asparaginase, suggesting a predisposition to this complication rather than a cumulative drug effect. Re-treatment with asparaginase after an episode of pancreatitis was associated with a high risk of recurrent pancreatitis.

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