Cerebral Sinus Occlusion in a Boy Presenting with Asparaginase-Induced Hypertriglyceridemia

Abstract

Cerebral sinus thrombosis is a rare but severe complication during treatment for acute lymphoblastic leukaemia (ALL). It mostly has been reported during treatment with asparaginase and dexamethasone. Hypertriglyceridemia has - albeit very rarely - also been associated with asparaginase therapy. The combination of cerebral sinus thrombosis and hypertriglyceridemia however, has not yet been reported. Here we describe a 15-year-old boy who presented with clinical symptoms and radiologic findings of a cerebral sinus thrombosis. In addition, a life-threatening hypertriglyceridemia was present. The complication was successfully treated by anticoagulation with low molecular weight heparin and the lipid regulator bezafibrate.

Severe hypertriglyceridaemia during therapy for childhood acute lymphoblastic leukaemia

“…A few case reports describe thrombosis in ALL patients with hypertriglyceridemia [7, 12] but in our study, approximately 20% of patients with severe hypertriglyceridemia developed venous thromboembolism. The combination of asparaginase, steroids and triglycerides causes a hypofibrinolytic state in the setting of hyperviscosity which may explain the increased risk of thromboembolism.…”

“…However, triglyceride levels >1,000 mg/dL in the general population increases the risk of acute pancreatitis [5, 6]. In addition, hypertriglyceridemia-induced hyperviscosity syndrome can lead to thromboembolic events [7, 8]. Lipid derangements may also contribute to the development of steroid-induced osteonecrosis [9, 10].…”

Asparaginase‐associated pancreatitis in children

“…Applicable treatment modalities include dietary restrictions, fibrates, statins, insulin‐glucose infusions, heparin infusions, and plasmapheresis. Generally, triglyceride levels are lowered significantly in a few days, but the efficacy of these approaches have not been formally evaluated (Dietel et al , ; Kfoury‐Baz et al , ; Ridola et al , ; Solano‐Paez et al , ).…”

Asparaginase‐associated pancreatitis is not predicted by hypertriglyceridemia or pancreatic enzyme levels in children with acute lymphoblastic leukemia

“…The significance of HTG in the development of toxicities remains unclear, and although preventive measures exist (e.g., dietary restrictions, fibrates, insulin infusions, heparin infusions, and plasmapherisis), it is uncertain to which degree such interventions reduce the risk of AAP or other potential HTG‐related toxicities, and routine preventive measures toward HTG cannot be recommended currently.…”