Serial Ultrasound Monitoring for Early Recognition of Asparaginase Associated Pancreatitis in Children With Acute Lymphoblastic Leukemia.
BACKGROUND
Acute lymphoblastic leukemia (ALL) is the most common cancer in children and L-asparaginase is an essential component of the treatment. Cessation of L-asparaginase decreases event free survival. Acute pancreatitis is the toxicity that most commonly results in cessation of L-asparaginase. We tested whether serial ultrasound examinations could predict asparaginase-associated pancreatitis (AAP).


METHODS
Children (aged 1.0-17.9 years) with childhood ALL treated at the University Hospital Rigshopitalet, Copenhagen, according to the standard or intermediate risk arms of the NOPHO ALL2008 protocol, with PEG-asparaginase of 2 or 6 week intervals, for 30 weeks had their pancreas monitored using serial ultrasound in order to detect early signs of inflammation.


RESULTS
Nineteen of 31 eligible patients were included. Three of the included patients developed AAP. None of the patients, including the three patients that developed AAP, had signs of inflammatory edema or pancreas enzymes above three times the upper normal limit prior to AAP.


CONCLUSIONS
We found no signs of inflammatory edema within the pancreas on ultrasound during treatment with PEG-asparginase in our cohort prior to development of AAP or in patients that did not develop AAP.
a Department of Pediatrics and Adolescent Medicine , University Hospital Rigshospitalet , Copenhagen, Denmark.
Raheel Altaf
RA
Raja
a Department of Pediatrics and Adolescent Medicine , University Hospital Rigshospitalet , Copenhagen, Denmark.|b Institute of Clinical Medicine, Faculty of Medicine , University of Copenhagen , Copenhagen, Denmark.
Kjeld
K
Schmiegelow
c Department of Diagnostic Radiology, Ultrasound section , University Hospital Rigshospitalet , Copenhagen, Denmark.
Birthe Merethe
BM
Henriksen
a Department of Pediatrics and Adolescent Medicine , University Hospital Rigshospitalet , Copenhagen, Denmark.
Thomas
T
Leth Frandsen
D001215:Asparaginase / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D010195:Pancreatitis / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D014463:Ultrasonography
D001215:Asparaginase
L-asparaginase; children; leukemia; pancreatitis; ultrasound