ESPE2016 Poster Presentations Fat Metabolism and Obesity P1 (48 abstracts)
Severe Hypertriglyceridemia in Pediatric Oncology Patient
Gema Grau a , Nancy Portillo a , Ricardo López Almaraz b , Aizpea Echebarria b , Rosa Adán b , Amaia Rodriguez a , Amaia Vela a , Itziar Astigarraga b & Itxaso Rica a
aCruces University Hospital, Pediatric Endocrinology, Barakaldo, Vizcaya, Spain; bCruces University Hospital. Pediatric Oncology, Barakaldo, Vizcaya, Spain
Background: Severe Hypertriglyceridemia (HTG) defined as triglycerides (TG) in blood plasma higher than 1000 mg/dl is a rare condition in childhood. Its causes are classified as primary and secondary and among these last they include pharmacological causes. Steroids associated with some chemotherapy drugs, particularly asparaginase (Asp), are a combination with special risk.
Objective and hypotheses: Describe the evolution of lipids profile in LLA patients, treated with Steroids-Asp.
Method: Retrospective descriptive study of cases of severe HTG in patients with acute lymphoblastic leukemia (ALL) treated in a tertiary hospital in 2010–2015. We have studied the prevalence of this disorder and its characteristics. Patients were treated on the LLA SHOP-2005 or LLA SHEOP-PETHEMA 2013 with an average of 23 dose of intramuscular Steroids-Asp (prednisone 60 mg/m2 per day, or dexamethasone 8 mg/m2 per day)/patient and distributed in three blocks of treatment (induction, intensification or re-induction, and maintenance).
Results: 45 patients were diagnosed with ALL (mean age 5 years old, male/female: 1.5/1). Protocols: ALL SHOP-2005 (49%) and ALL SHEOP-PETHEMA 2013 (51%); 102 estimated blocks with Steroids-Asp administration. It was found severe HTG in four patients with steroid-Asp (prevalence of 4%). The mean age was 7 years. Three were high-risk ALL. No relationship with other medications received was found. The evolution of HTG was adequate regardless of the therapeutic approach. No acute clinical complications. The medium-term evolution was (Table 1):
| Patient | Age (years) | TG (mg/dl) | Treatment | TG 3 days (mg/dl) | TG 1 week (mg/dl) | TG 3 months (mg/dl) |
| A | 14.5 | >7.000 | Bezafibrate (6 mg/kg/día) | 2,836 | 244 | NA |
| B | 7.7 | 6.280 | Bezafibrate (10 mg/kg/día) | 323 | 123 | 91 |
| C | 5.9 | 2.200 | None | 252 | 340 | 314 |
| D | 3.5 | 3.799 | None | 771 | 522 | 171 |
Conclusion: The Asp and steroids can produce a transient severe HTG. Its management is based on dietary modifications +/− lipid lowering agents, and close monitoring without altering chemotherapy. No serious acute complications observed in any case.
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