Transient, severe hyperlipidemia in patients with acute lymphoblastic leukemia treated with prednisone and asparaginase

Abstract Background . Corticosteroids and asparaginase inhibit protein synthesis. Many of their side effects are familiar to oncologists. Conversely, the possibility of therapy‐induced hyperlipidemia generally is not appreciated. The incidence of severe hyperlipidemia during therapy of patients with acute lymphoblastic leukemia (ALL) who received prednisone and asparaginase was evaluated. Methods . During therapy with prednisone and asparaginase, a 10‐year‐old girl with precursor B ALL was identified with a peak plasma triglyceride and cholesterol level of 20,600 mg/dl and 1640 mg/dl, respectively. The lipid profile of the 60 patients in the protocol with this patient, the lipid profile of 64 patients on the previous high‐risk ALL therapy program, and the literature were reviewed. Results . Five of 60 patients on the New York‐II protocol experienced transient, marked (triglyceride level ⩾ 1000 mg/dl), benign hyperlipidemia. No such problem was observed in the 64 patients on the New York‐I protocol. Five similar cases were found in the literature during therapy with steroids (2), asparaginase (2), or both (1). There were no characteristics that distinguished these 10 patients from the vast majority of patients on similar therapy without severe hyperlipidemia. Prolonged therapy with either agent seemed to increase the possibility of hyperlipidemia. Conclusion. Severe hyperlipidemia during induction therapy for ALL is random, transient, and benign. Given the serious nature of the underlying disorder and the value of asparaginase and prednisone in its treatment, antileukemic therapy should not be modified when severe hyperlipidemia is observed.