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. 2024 Jul 24;16(15):2640.
doi: 10.3390/cancers16152640.

Acute Pancreatitis in Pediatric Acute Lymphoblastic Leukemia (AcuPA Study): A Nationwide Survey in Poland

Anna Morawiak  1 , Małgorzata Salamonowicz-Bodzioch  2 , Aleksandra Królak  1 , Krzysztof Kałwak  2 , Joanna Owoc-Lempach  2 , Jerzy Kowalczyk  3 , Joanna Zawitkowska  3 , Tomasz Szczepański  4 , Ninela Irga-Jaworska  5 , Elżbieta Adamkiewicz-Drożyńska  5 , Katarzyna Albrecht  6 , Anna Szmydki-Baran  6 , Walentyna Balwierz  7 , Małgorzata Czogała  7 , Jacek Wachowiak  8 , Katarzyna Derwich  8 , Wojciech Młynarski  9 , Beata Zalewska-Szewczyk  9 , Maryna Krawczuk-Rybak  10 , Małgorzata Sawicka-Żukowska  10 , Jan Styczyński  11 , Andrzej Kołtan  11 , Krzysztof Safranow  12 , Tomasz Urasiński  1 , Tomasz Ociepa  1
Affiliations

Acute Pancreatitis in Pediatric Acute Lymphoblastic Leukemia (AcuPA Study): A Nationwide Survey in Poland

Anna Morawiak et al. Cancers (Basel). .

Abstract

Purpose: This study aimed to identify the risk factors for acute pancreatitis (AP) and its impact on outcomes in Polish children treated for ALL.

Methods: The study group included 2303 children receiving intensive chemotherapy for ALL. The group was divided into patients with at least one episode of AP and those who did not develop AP after treatment for ALL.

Results: The cumulative incidence of AP in the study group was 4.08%. Older age was an independent risk factor for the development of AP (OR = 1.05; 95%CI = 1.006-1.098; p = 0.03). The overall mortality associated with AP was 2.13%. The probabilities of disease-free survival (p-DFS) and event-free survival (p-EFS) in both subgroups were 0.84 vs. 0.86, log-rank p = 0.65 and 0.75 vs. 0.80, log-rank p = 0.12, respectively. A total of 22 out of 94 patients (23.4%) with AP were re-exposed to asparaginase (ASP) during the subsequent treatment phases. Only one patient re-exposed to ASP (4.5%) developed a second episode of AP. There were no significant differences in p-DFS and p-EFS between patients re-exposed and not re-exposed to asparaginase (0.78 vs. 0.86, log-rank p = 0.27 and 0.63 vs. 0.79, log-rank p = 0.09, respectively).

Conclusions: The incidence of AP in children with ALL is low and related to patients' age. The development of AP does not seem to influence p-DFS and p-EFS in children with ALL. Recurrence of AP after re-exposure to asparaginase in patients with ALL and a history of AP is low (4.5%). Re-exposure to asparaginase after the first episode of AP does not improve either p-DFS or p-EFS in children with ALL.

Keywords: acute lymphoblastic leukemia; acute pancreatitis; asparaginase; children; intensive chemotherapy; risk factors.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The distribution of acute pancreatitis across the age groups.
Figure 2
Figure 2
Probability of disease-free survival (A) and event-free survival (B) in Groups 1 and 2.
Figure 3
Figure 3
The probability of disease-free survival (A) and event-free survival (B) in ASP+ and ASP− groups.
See this image and copyright information in PMC

References

    1. Kaatsch P. Epidemiology of childhood cancer. Cancer Treat. Rev. 2010;36:277–285. doi: 10.1016/j.ctrv.2010.02.003. - DOI - PubMed
    1. Vora A., Goulden N., Wade R., Mitchell C., Hancock J., Hough R., Rowntree C., Richards S. Treatment reduction for children and young adults with low-risk acute lymphoblastic leukaemia defined by minimal residual disease (UKALL 2003): A randomised controlled trial. Lancet Oncol. 2013;14:199–209. doi: 10.1016/S1470-2045(12)70600-9. - DOI - PubMed
    1. Pui C.H., Pei D., Campana D., Cheng C., Sandlund J.T., Bowman W.P., Hudson M.M., Ribeiro R.C., Raimondi S.C., Jeha S., et al. A revised definition for cure of childhood acute lymphoblastic leukemia. Leukemia. 2014;28:2336–2343. doi: 10.1038/leu.2014.142. - DOI - PMC - PubMed
    1. Zawitkowska J., Lejman M., Romiszewski M., Matysiak M., Ćwiklińska M., Balwierz W., Owoc-Lempach J., Kazanowska B., Derwich K., Wachowiak J., et al. Results of two consecutive treatment protocols in Polish children with acute lymphoblastic leukemia. Sci. Rep. 2020;10:20168. doi: 10.1038/s41598-020-75860-6. - DOI - PMC - PubMed
    1. Maloney K.W., Devidas M., Wang C., Mattano L.A., Friedmann A.M., Buckley P., Borowitz M.J., Carroll A.J., Gastier-Foster J.M., Heerema N.A., et al. Outcome in Children with Standard-Risk B-Cell Acute Lymphoblastic Leukemia: Results of Children’s Oncology Group Trial AALL0331. J. Clin. Oncol. 2020;38:602–612. doi: 10.1200/JCO.19.01086. - DOI - PMC - PubMed

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