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Acute Pancreatitis in Children With Acute Lymphoblastic Leukemia After Chemotherapy

Treepongkaruna, Suporn MD; Thongpak, Naporn MD; Pakakasama, Samart MD; Pienvichit, Paneeya MD; Sirachainan, Nongnuch MD; Hongeng, Suradej MD

Journal of Pediatric Hematology/Oncology: November 2009 - Volume 31 - Issue 11 - p 812-815
doi: 10.1097/MPH.0b013e3181b87035
Original Articles
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Background Acute pancreatitis (AP) is a complication in children with acute lymphoblastic leukemia (ALL) receiving chemotherapy and has often been reported associated with L-asparaginase (L-asp) therapy.

Objectives To determine the incidence, risk factors, clinical data, outcome, and mortality of AP in children with ALL.

Methods Retrospective cohort study was conducted by reviewing the data of total 192 pediatric ALL patients from Pediatric Oncology Registry at Ramathibodi Hospital from 2000 to 2006 to assess incidence, clinical data, outcome, and mortality of AP. Then, a nested case-control study was conducted to identify potential risk factors for AP by recruiting all patients with AP as cases (n=16), and randomly selected patients without AP to serve as controls up to approximately four controls per case with the total of 68 controls.

Results The total incidence of AP in children with ALL and L-asp-associated AP was 8.3% and 7.3%, respectively. In patients with L-asp-associated AP, pancreatitis developed after the median 5.5 doses (range: 1 to 20 doses) of L-asp therapy and the median interval from the last dose of L-asp to the onset of AP was 4 days (range: 1 to 13 days). The mortality rate of AP group was significantly higher than the patients without AP (43.8% vs. 19.3%, P=0.02). Mortality was associated with concurrent systemic infection and complications of underlying diseases. Multivariate analysis identified using a high-risk chemotherapy regimen was the only risk factor for AP.

Conclusions Using a high-risk chemotherapy regimen was a risk factor for pancreatitis in patients with ALL. ALL children with AP had higher mortality rate than those without pancreatitis.

Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Reprints: Suporn Treepongkaruna, MD, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama 6 Road, Bangkok 10400, Thailand (e-mail: rastp@mahidol.ac.th).

Received for publication December 12, 2008

accepted July 19, 2009

This work was funded by Ramathibodi Research Grant, Faculty of Medicine, Ramathibodi Hospital, Mahidol University. None of the authors has commercial associations.

© 2009 Lippincott Williams & Wilkins, Inc.