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correspondence

Indian Pediatr 2011;49: 250

The Other Side of L-Asparaginase


Vikas Dua and Satya Prakash Yadav

Pediatric Hematology Oncology and  Bone Marrow Transplant Unit,  Department of Pediatrics, Institute of Child Health,
Sir Ganga Ram Hospital, Delhi 110 060, India.
Email: [email protected]
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We read the article on diabetic ketoacidosis (DKA) with L-asparaginase therapy by Mondal, et al. with interest [1]. They have reported two children with acute lymphoblastic leukemia (ALL) who developed DKA after treatment with L-asparaginase. We report our experience with L-asparaginase during treatment of children with ALL treated from 2005 to Aug 2011 on UKALL-XI protocol. Out of 235 patients of ALL, nine children had pancreatic complications- three DKA, three hyperglycemia and three acute pancreatitis. All of them recovered.

Thrombosis, another well described complication with L-Asparginase [2], was seen in 14 (5.96 %) children. Ten happened during the induction phase and four in re-induction phase of therapy. Twelve patients had seizure and MRI revealed superior sagittal thrombosis in five and infarcts in seven patients. Two patients developed lower limb thrombosis. Median fibrinogen in these 14 patients was 1 g/L (range 0.9 to 1.4 g/L). Two patients expired during this episode and one went into vegetative state [3].

Fourteen patients developed hypersensitivity, four developed localized reaction and ten had generalized hypersensitivity reaction requiring change of medication.

We suggest children undergoing L-asparginase therapy should not only have regular blood sugar monitoring and screening for DKA but also have serum fibrinogen monitoring for prevention and early imaging for detection of thrombosis. In case of systemic allergic reaction, change to alternative preparation should be considered.

References

1. Mondal R, Nandi M, Tiwari A, Chakravorti S. Diabetic ketoacidosis with L-asparaginase therapy. Indian Pediatr. 2011;48:735-6.

2. Beinart G, Damon L. Thrombosis associated with L-asparaginase therapy and low fibrinogen levels in adult acute lymphoblastic leukemia. Am J Hematol. 2004;77:331-5.

3. Dua V, Yadav SP, Ramzan M, Dinand V, Kharya G, Bhat S, et al. Thrombosis during induction phase of childhood acute lymphoblastic leukemia- a single center experience from developing world. Pediatric Blood and Cancer (SIOP abstract). 2011;57:762.

 

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