Hypoglycemia associated with L-asparaginase in acute lymphoblastic leukemia treatment: a case report

Tanaka, Ryuma; Osumi, Tomoo; Miharu, Masashi; Ishii, Tomohiro; Hasegawa, Tomonobu; Takahashi, Tsuyoshi; Shimada, Hideaki

doi:10.1186/2162-3619-1-8

Cited by 10 publications

(16 citation statements)

References 17 publications

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“…L-Asp-induced hypoglycemia occurs through hyperinsulinism. 16,17 However, we did not examine subjects' insulin level. Seven subjects had hypoglycemia as well as hyperglycemia, with 3 subjects experiencing hypoglycemia first, followed by hyperglycemia, with fasting BG ranging from 56 mg/dL to 64 mg/dL; none of them had two-hour postprandial hypoglycemia, whereas BG in the hyperglycemia episode ranged from 211 mg/dL to 388 mg/dL two-hour postprandial, and 267 mg/dL in one episode of fasting hyperglycemia.…”

Section: Discussionmentioning

confidence: 99%

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

Andria¹,

Moelyo²,

Reza³

2020

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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.

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Section: Discussionmentioning

confidence: 99%

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

Andria¹,

Moelyo²,

Reza³

2020

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“…In fact, hypoglycemia is not unusual in children with ALL in response to induction chemotherapy. Case reports and clinical trials have shown that, for children of lower age, cases of hypoglycemia are more common than hyperglycemia [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Induction chemotherapy reduces extracellular heat shock protein 72 levels, inflammation, lipoperoxidation and changes insulin sensitivity in children and adolescents newly diagnosed with acute lymphoblastic leukemia

et al. 2018

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BackgroundAcute lymphoblastic leukemia (ALL) is associated with higher levels of pro-inflammatory cytokines and oxidative stress. Recently, the levels of extracellular heat shock protein 72 (eHSP72) were found to be elevated in ALL, and its elevation associated with poor prognosis. Therefore, considering the possible role of eHSP72 as a modulator of the immunological system and metabolism, the aim of this study was to describe the response of eHSP72 to the induction phase of chemotherapy, along with metabolic, inflammatory and oxidative stress markers, in children and adolescents newly diagnosed with ALL.MethodsNineteen patients were recruited and analysed before and after the induction phase of chemotherapy (with 28 days of duration). Blood samples were taken for the analysis of C-reactive protein (CRP), levels of lipoperoxidation, insulin (and HOMA-IR), cortisol, glucose, lipid profile and eHSP72.ResultsWe found that induction phase of chemotherapy leads to a drop in glucose levels (from 101.79±19 to 75.8±9.7 mg/dL), improvements on inflammation (CRP levels, p<0.01) and oxidative stress (TBARS levels, p<0.01), reduction on eHSP72 (p=0.03) and improved insulin sensitivity (HOMA-IR, p=0.02).ConclusionOur results indicate that eHSP72 may have an immune and metabolic role and could be used as a marker of the treatment success and metabolic changes in children with ALL.

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“…in 2012 have reported that inappropriate insulin secretion, normal free fatty acids, and low ketone bodies during severe hypoglycemia indicate hyperinsulinism, suggesting that L-Asp-induced hypoglycemia is a result of insulin hypersecretion. [ 9 ] There were no other drugs that could have potentially induced hypoglycemia during the study period. [ 13 ] There are few reports focusing on fasting glucose levels in the morning.…”

Section: Discussionmentioning

confidence: 99%

“…[ 5 6 7 8 ] Although literature scan reveals hyperglycemia as the most important metabolic side effect of L-Asp, two anecdotal reports of L-Asp-induced hypoglycemia have also been reported (Tokyo, Japan, and Kashmir, India). [ 9 10 ] Analysis of important adverse drug reaction (ADR) profile of one drug and trying to find out its in-depth mechanism can help clinicians to develop strategies to prevent and manage the ADR in a planned way. Thus, the present study was designed to identify the nature and incidence of L-Asp-induced abnormal glucose level in a tertiary care setup.…”

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confidence: 99%

L-asparaginase-induced abnormality in plasma glucose level in patients of acute lymphoblastic leukemia admitted to a tertiary care hospital of Odisha

et al. 2016

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Objectives:The objective of this study was to evaluate any abnormal change in plasma glucose levels in patients treated with L-asparaginase (L-Asp)-based chemotherapy regimen in patients of acute lymphoblastic leukemia (ALL).Materials and Methods:This retrospective, hospital-based study was conducted in patients of ALL, admitted to the Clinical Haematology Department of a tertiary care hospital of Odisha from August 2014 to July 2015. Indoor records of 146 patients on multi-centered protocol-841 were evaluated for any alteration in plasma glucose level, time of onset of hypo/hyperglycemia, and persistence of plasma glucose alteration.Results:Twenty-one percent of patients showed abnormal plasma glucose level. Most of these patients developed hypoglycemia and were of lower age group. Most of these patients developed hypoglycemia and were of lower age group, whereas a majority of higher age group patients developed hyperglycemia. In majority of the cases, abnormal glucose developed after three doses of L-Asp. Hypoglycemia subsided whereas hyperglycemia persisted till the end of our observation period.Conclusions:L-Asp produces more incidences of hypoglycemia than hyperglycemia in a good number of ALL patients towards which clinicians should be more vigilant. However, hyperglycemia persists for a longer duration than hypoglycemia.

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Hypoglycemia associated with L-asparaginase in acute lymphoblastic leukemia treatment: a case report

Cited by 10 publications

References 17 publications

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

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

Induction chemotherapy reduces extracellular heat shock protein 72 levels, inflammation, lipoperoxidation and changes insulin sensitivity in children and adolescents newly diagnosed with acute lymphoblastic leukemia

L-asparaginase-induced abnormality in plasma glucose level in patients of acute lymphoblastic leukemia admitted to a tertiary care hospital of Odisha

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