Asparaginase-associated pancreatitis (AAP) in pediatric patients is often severe and has a high risk for complications, according to a case series published in the Journal of Pediatric Gastroenterology and Nutrition.
L-asparaginase, a chemotherapeutic agent used in the treatment of acute lymphoblastic leukemia (ALL), has the potential to cause pancreatitis. Researchers retrospectively assessed the clinical course of patients who received treatment at Boston Children’s Hospital while participating in a Dana-Farber Cancer Institute ALL clinical trial between 2005 and 2015. Patients who developed pancreatitis during a treatment involving asparaginase were prospectively identified as having AAP.
Of 1004 total patients included in the ALL study cohort, 34 developed AAP. Study participants from the pancreatitis cohort had a median age of 7.7 (IQR, 2.6-17.8) years, 44.1% were girls, 55.9% were White, and 70.2% were Asian, Black, or categorized as “Other.”
The median inpatient length of stay was 10 days, which was longer than the 3-day median length of stay for pediatric acute pancreatitis caused by other etiologies. Intensive care was needed for 16.3% of patients, for a median length of 4 days. While the clinical course varied greatly by individual, 39.5% of AAP episodes were classified as severe, according to national standards for acute pancreatitis.
Rates of antibiotic and/or total parenteral nutrition usage were higher in patients with AAP compared with standard of care, though there were many confounders, such as the immunocompromised state of a patient with ALL and the ordering tendencies of different specialties. Of the patients who resumed treatment with L-asparaginase, 33% experienced another episode of AAP.
Researchers noted that further research is needed to identify specific risk factors for the development of AAP, but “clinicians caring for patients with ALL should be vigilant to the variable clinical course of AAP, including the possibility of rapid cardiovascular decompensation requiring intensive care unit-level care.”
Mauney EE, Power-Hays A, Flamand Y, Vrooman L, Silverman LB, Grover AS. Clinical characteristic and short-term outcomes of children with asparaginase-associated pancreatitis. J Pediatr Gastroenterol Nutr. 2022;74(3): 402-407. doi:10.1097/MPG.0000000000003334