Blood glucose level during induction phase chemotherapy in childhood acute lymphoblastic leukemia

Abstract

Background Steroids and L-asparaginase (L-Asp) are agents used in induction phase chemotherapy for childhood acute lymphoblastic leukemia (ALL). Both agents are often reported to have the side effect of hyperglycemia, and native L-Asp is also reported to cause hypoglycemia. In ALL patients, hyperglycemic events during chemotherapy can cause lower 5-year overall and relapse-free survival.
 Objective To investigate the incidence of abnormal blood glucose level (BG) as the side effect of prednisone and L-Asp during induction phase chemotherapy, its predisposing factors, and its effect on remission status.
 Methods This cohort prospective study was conducted in 36 children aged 1-18 years who were newly diagnosed with childhood ALL at Dr. Moewardi Hospital, Surakarta, Central Java. Subjects’ nutritional status consist of wellnourished and undernourishment. Subjects underwent BG monitoring. At the end of induction phase chemotherapy, subjects underwent bone marrow puncture (BMP) evaluation to assess their response to chemotherapy and the effect of abnormal BG on remission status.
 Results Hypoglycemia, a combination of hypoglycemia and hyperglycemia, hyperglycemia, as well as euglycemia, were experienced by 9, 7, 6, and 14 subjects, respectively. Nutritional status was found to be a significant risk factor for abnormal BG. There was no significant difference in remission status at the end of induction phase chemotherapy between the euglycemic group and abnormal BG groups (P=0.533).
 Conclusion Abnormal BG during induction phase chemotherapy did not affect remission status at the end of induction phase. Undernourishment is also found to be a predisposing factor in abnormal BG.

Quality of life of children with acute lymphoblastic leukemia

“…26 The better QoL was in agreement with the success rate of remission in children with ALL which reached 80% in Indonesia. 27 The high children's QoL score could have been closely related to large numbers of children in the maintenance phase of chemotherapy. During this phase, children receive anti-cancer agents less intensively than in previous phases, therefore, side effects of treatment are generally milder.…”

Drug Induced Diabetes Mellitus in Pediatric Acute Lymphoblastic Leukemia: Approach to Diagnosis and Management

“…Hence, Endocrine Society guidelines on the management of hyperglycemia in earlier nondiabetic, noncritically ill hospitalized patients on steroid therapy advocates discontinuation of monitoring after 24 to 48 hours if all measured blood glucose values are normal 27,28. But a recent study conducted in children with ALL noticed that, during induction phase, hyperglycemia can develop anywhere between the first to fifth week after initiation of steroids 29. Similarly, nondiabetic adults with ALL on steroid therapy were shown to have hyperglycemic episodes between 2 and 4 weeks after initiation of induction chemotherapy 30.…”

“…27,28 But a recent study conducted in children with ALL noticed that, during induction phase, hyperglycemia can develop anywhere between the first to fifth week after initiation of steroids. 29 Similarly, nondiabetic adults with ALL on steroid therapy were shown to have hyperglycemic episodes between 2 and 4 weeks after initiation of induction chemotherapy. 30 These findings were replicated in other studies involving adults, secondary to glucocorticoid exposure in non-ALL settings.…”

Drug induced Diabetes Mellitus (DIDM) in Pediatric Acute Lymphoblastic Leukemia (ALL): Approach to diagnosis and management

“…Hence Endocrine Society guidelines on management of hyperglycaemia in earlier non-diabetic, non-critically ill hospitalised patients on steroid therapy advocates discontinuation of monitoring after 24-48 hours if all measured blood glucose values are normal(29) (30). But a recent study conducted in children with ALL noticed that, during Induction phase hyperglycemia can develop anywhere between first to fifth week after initiation of steroids (31). Similarly, non-diabetic adults with ALL on steroid therapy were shown to have hyperglycemic episodes between 2-4 weeks after initiation of induction chemotherapy (32).…”