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 20102015. 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|
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.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology