title: Insulin infusion to treat severe hypertriglyceridemia associated with pegaspargase therapy: a case report.
abstract: We describe a pediatric patient with acute leukemia who developed an uncommon but significant metabolic consequence of pegaspargase therapy-severe hypertriglyceridemia (hyperTG). We also relate our experience with continuous insulin infusion treatment for pegaspargase-induced hyperTG. This treatment approach led to a decrease in triglycerides from 4640 mg/dL on admission to 522 mg/dL at discharge 9 days later. Genetic testing revealed that our patient was an apolipoprotein E 3/4 heterozygote. Our review of the literature suggests that apolipoprotein E polymorphism may influence the development of hyperlipidemia in acute lymphoblastic leukemia patients receiving asparaginase therapy and may identify patients at high risk for developing asparaginase-induced hyperTG.
authors.affiliation: UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, San Diego, CA, USA. ebrigid@ucsd.edu
authors.forename: Eileen B
authors.initials: EB
authors.lastname: Lawson
authors.forename: Michael
authors.initials: M
authors.lastname: Gottschalk
authors.forename: Deborah E
authors.initials: DE
authors.lastname: Schiff
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001215:Asparaginase / Q000009:adverse effects*; D002648:Child; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D006801:Humans; D015228:Hypertriglyceridemia / Q000139:chemically induced* / Q000188:drug therapy*; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D007938:Leukemia / Q000188:drug therapy*; D008297:Male; D015122:Mercaptopurine / Q000008:administration & dosage; D011092:Polyethylene Glycols / Q000009:adverse effects*
chemical_list: D000970:Antineoplastic Agents; D007328:Insulin; D003561:Cytarabine; D011092:Polyethylene Glycols; C042705:pegaspargase; D003520:Cyclophosphamide; D015122:Mercaptopurine; D001215:Asparaginase