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Asparaginase‐associated pancreatitis in children with acute lymphoblastic leukaemia in the NOPHO ALL 2008 protocol
Author(s) -
Raja Raheel A.,
Schmiegelow Kjeld,
Albertsen Birgitte K.,
Prunsild Kaie,
Zeller Bernward,
Vaitkeviciene Goda,
Abrahamsson Jonas,
Heyman Mats,
Taskinen Mervi,
HarilaSaari Arja,
Kanerva Jukka,
Frandsen Thomas L.
Publication year - 2014
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.12733
Subject(s) - asparaginase , medicine , pancreatitis , acute pancreatitis , lymphoblastic leukemia , acute lymphocytic leukemia , immunology , pediatrics , leukemia
Summary L‐asparaginase is an important drug in the treatment of childhood acute lymphoblastic leukaemia ( ALL ). Treatment is associated with several toxicities, including acute pancreatitis. Clinical course, presentation, re‐exposure to L‐asparginase after pancreatitis and risk of recurrent pancreatitis within an asparaginase‐intensive protocol has been poorly reported. Children (1–17 years) on the ongoing N ordic S ociety of P aediatric H aematology and O ncology ( NOPHO ) ALL2008 protocol with asparaginase‐associated pancreatitis ( AAP ) diagnosed between 2008 and 2012 were identified through the online NOPHO ALL toxicity registry. NOPHO ALL2008 includes eight or 15 doses of intramuscular pegylated L‐asparginase ( PEG ‐asparaginase) 1000 iu/m 2 /dose at 2–6 weeks intervals, with a total of 30 weeks of exposure to PEG ‐asparaginase (clinicaltrials.gov no: NCT00819351). Of 786 children, 45 were diagnosed with AAP with a cumulative risk of AAP of 5·9%. AAP occurred after a median of five doses (range 1–13), and 11 d (median) from the latest administration of PEG ‐Asparaginase. Thirteen patients developed pseudocysts (30%) and 11 patients developed necrosis (25%). One patient died from pancreatitis. Twelve AAP patients were re‐exposed to L‐asparginase, two of whom developed mild AAP once more, after four and six doses respectively. In conclusion, re‐exposure to PEG ‐asparaginase in ALL patients with mild AAP seems safe.