Minimal contribution of severe hypertriglyceridemia in L-asparaginase-associated pancreatitis developed in a child with acute lymphocytic leukemia.
A 10-year-old girl developed L-asparaginase (ASP)-associated pancreatitis during chemotherapy for acute lymphocytic leukemia. Her symptoms showed alleviation with continuous regional arterial infusion of protease inhibitor and systemic somatostatin analog therapy. She had intermittent and marked hypertriglyceridemia, an initial trigger for pancreatitis, probably as a side effect of ASP and steroids. However, we considered the pancreatitis to have developed mainly because of factors other than hypertriglyceridemia as lipoprotein analysis confirmed chylomicron levels to be nearly undetectable. Extremely large chylomicrons contribute directly to the onset of pancreatitis by causing blockage of small vessels. Although it is necessary to examine patients for dyslipidemia developing as a side effect of ASP, therapeutic intervention for hypertriglyceridemia is not considered to prevent the onset of ASP-associated pancreatitis.
Division of Gastroenterological Medicine, Kanazawa University Hospital.
Yoshinori
Y
Goto
Ryosei
R
Nishimura
Atsushi
A
Nohara
Shintaro
S
Mase
Toshihiro
T
Fujiki
Hitoshi
H
Irabu
Rie
R
Kuroda
Raita
R
Araki
Yasuhiro
Y
Ikawa
Hideaki
H
Maeba
Akihiro
A
Yachie
D001215:Asparaginase / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D005260:Female; D006801:Humans; D015228:Hypertriglyceridemia / Q000209:etiology*; D050356:Lipid Metabolism; D010195:Pancreatitis / Q000139:chemically induced*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*
D001215:Asparaginase