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Indian Pediatr 2011;49: 250
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The Other Side of L-Asparaginase
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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] om
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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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