title: A case report of an adult with severe hyperlipidemia during acute lymphocytic leukemia induction therapy successfully treated with plasmapheresis.
abstract: Plasmapheresis for the treatment of hypertriglyceridemia has previously been performed in patients with sudden onset severe hypertriglyceridemia and acute pancreatitis; however, only a few reports of this procedure have been published. We report here on a case showing severe hypertriglyceridemia during asparaginase (Asp) treatment for acute lymphocytic leukemia (ALL), and give an overview of a lipid-lowering apheresis therapy. To prevent the complication of pancreatitis due to hypertriglyceridemia, we performed plasma exchange (PE) three times using fresh frozen plasma. PE remarkably reduced both serum triglyceride and total cholesterol levels from 5430 mg/dL to 403 mg/dL and from 623 mg/dL to 204 mg/dL, respectively. The causes of severe hyperlipidemia in this patient were considered to include: the Asp treatment for ALL, and a genetic background with a heterozygote of familial lipoprotein lipase (LPL) defect syndrome, because the patient's plasma LPL level after intravenous heparin injection was low at 137 ng/mL. Hence, PE using fresh frozen plasma may be useful not only to remove lipoproteins, but also to supply defective factors, such as LPL, in similar cases.
authors.affiliation: Division of Nephrology, Kanazawa Medical University, Uchinada, Japan. yam99845@yahoo.co.jp
authors.forename: Masaru
authors.initials: M
authors.lastname: Nakagawa
authors.forename: Syogo
authors.initials: S
authors.lastname: Kimura
authors.forename: Keiji
authors.initials: K
authors.lastname: Fujimoto
authors.forename: Hirokatsu
authors.initials: H
authors.lastname: Atumi
authors.forename: Jyunko
authors.initials: J
authors.lastname: Imura
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Chikazawa
authors.forename: Hidetsugu
authors.initials: H
authors.lastname: Imamura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okuyama
authors.forename: Hideki
authors.initials: H
authors.lastname: Yamaya
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Fukushima
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakagawa
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Asaka
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yokoyama
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001215:Asparaginase / Q000009:adverse effects / Q000627:therapeutic use; D002784:Cholesterol / Q000097:blood; D006801:Humans; D015228:Hypertriglyceridemia / Q000209:etiology / Q000628:therapy*; D008071:Lipoprotein Lipase / Q000172:deficiency / Q000235:genetics / Q000378:metabolism; D008297:Male; D010956:Plasmapheresis / Q000379:methods*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy; D012074:Remission Induction; D012720:Severity of Illness Index; D014280:Triglycerides / Q000097:blood; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D014280:Triglycerides; D002784:Cholesterol; D008071:Lipoprotein Lipase; D001215:Asparaginase