A case report of an adult with severe hyperlipidemia during acute lymphocytic leukemia induction therapy successfully treated with plasmapheresis.
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.
Nakagawa
Masaru
M
Division of Nephrology, Kanazawa Medical University, Uchinada, Japan. yam99845@yahoo.co.jp
Kimura
Syogo
S
Fujimoto
Keiji
K
Atumi
Hirokatsu
H
Imura
Jyunko
J
Chikazawa
Yoshihiro
Y
Imamura
Hidetsugu
H
Okuyama
Hiroshi
H
Yamaya
Hideki
H
Fukushima
Toshihiro
T
Nakagawa
Atsushi
A
Asaka
Mitsuhiro
M
Yokoyama
Hitoshi
H
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
D000970:Antineoplastic Agents; D014280:Triglycerides; D002784:Cholesterol; D008071:Lipoprotein Lipase; D001215:Asparaginase