Pegaspargase-induced pancreatitis.
BACKGROUND
The purpose of this study is to report the incidence of pancreatitis in patients treated with pegaspargase in our hospital during a 2-year period.


METHODS
We identified episodes of pancreatitis related to the intramuscular administration of pegaspargase 2,500 IU/m(2) for the treatment of childhood hematological malignancies during a 2-year period (May 1996-April 1998). Patients were evaluated clinically and by sequential serum amylase and lipase determinations and radiographic examinations. For comparison, episodes of pancreatitis in patients who only received native Escherichia coli L-asparaginase were examined during the same time period.


RESULTS
Nine children with acute lymphoblastic leukemia (ALL) of 50 (18%) patients who received pegaspargase were diagnosed to have pancreatitis. All had prior therapy with native L-asparaginase. These children developed symptoms consisting of abdominal pain, nausea, vomiting, and decreased appetite within a median of 15 days from the onset of pegaspargase administration. Six patients became symptomatic after their initial dose. Seven patients developed severe or unacceptable toxicity (grades 3 and 4), measured by increased amylase (>2 times normal) and lipase levels or radiographic evidence of pancreatic inflammation or pseudocyst. One patient also developed hyperammonemia and encephalopathy. In contrast, only one out of 52 (1.9%) ALL patients who received native E. coli L-asparaginase during the same time period developed pancreatitis (P= 0.007).


CONCLUSIONS
Clinicians should be aware of a possible higher incidence of pancreatitis associated with pegaspargase.
Alvarez
O A
OA
Division of Hematology-Oncology, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California 92350, USA.
Zimmerman
G
G
D000293:Adolescent; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001215:Asparaginase / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004800:Enzymes, Immobilized / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D010195:Pancreatitis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000201:enzymology; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000009:adverse effects*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011859:Radiography
D000970:Antineoplastic Agents; D004800:Enzymes, Immobilized; D011092:Polyethylene Glycols; C042705:pegaspargase; D001215:Asparaginase