Fasting hypoglycemia is common during maintenance therapy for childhood acute lymphoblastic leukemia

Symptomatic hypoglycemia in children receiving oral purine analogues for treatment of childhood acute lymphoblastic leukemia

“…We rather focused on the occurrence of SH observed in some patients during early morning hours. The 6.9% incidence of SH observed in our patients is far lower than the 50% incidence of abnormal fasting tolerance experimentally induced by Halonen et al [3] Such episodes were usually frightening and in some cases, the parents urgently took the children to the hospital, although the episodes had either reversed or could be easily controlled by oral administration of a sugar-containing food or liquid. Prospective monitoring of blood glucose over the following days allowed documentation of recurrent episodes of SH in some patients.…”

“…Meanwhile, the recent report from Halonen et al [3] strengthened our suspicion that SH might represent a treatment-dependent event, which might have been previously overlooked.…”

“…In their study Halonen et al [3] induced hypoglycemia by extending the overnight fasting to 16 hr, and documented that one-half of the patients had abnormal fasting tolerance. We rather focused on the occurrence of SH observed in some patients during early morning hours.…”

“…Halonen et al [3] describe the incidence of reduced fasting tolerance, resulting in hypoglycemia, only during continuation therapy. In our experience, one-half of the episodes of SH were observed during other treatment phases, i.e., consolidation and reinduction therapy.…”

“…Recently, Halonen et al [3] reported fasting hypoglycemia to be a very common, but reversible adverse effect of continuation therapy for childhood ALL. In their study of 35 consecutive Finnish patients, 16-hr overnight fasting was followed by hypoglicemia in 19 children (54%).…”