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

Abstract

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.

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

“…Native L-Asp, on the contrary, was reported to result in more hypoglycemia than hyperglycemia during chemotherapy in childhood ALL. 7 Seven of 9 subjects in our hypoglycemia group suffered from hypoglycemia after the second dose administration of L-Asp in the second week, with fasting BG ranging from 40 mg/ dL to 64 mg/dL, and 58 mg/dL in one episode of twohour postprandial BG. L-Asp-induced hypoglycemia occurs through hyperinsulinism.…”

“…6 Native L-Asp, produces more incidences of hypoglycemia than hyperglycemia during chemotherapy for childhood ALL. 7 To our knowledge, there have been no studies on the impact of hypoglycemia during chemotherapy on survival rate. As such, we aimed to investigate the incidence of abnormal blood glucose level (BG) as the side effect of prednisone and L-Asp used in inductive phase chemotherapy, predisposing factors of abnormal BG, and the effect of abnormal BG on remission status.…”

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

“…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 ].…”

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“…A case report by Kumar et al showed an unusual pattern of nail pigmentation following a Cyclophosphamide-containing chemotherapy regimen in a 60-year-old female patient with breast cancer. 23 It was found that L-asparaginase (L-Asp)-based chemotherapy regimen when used in patients of acute lymphoblastic leukemia ALL) produces more incidences of hypoglycemia than hyperglycemia, thus showing the abnormal change in plasma glucose levels 24 . A study done by Anwikar et al, showed that there is a possibility of tetany by bevacizumab, which may occur by interfering with calcium metabolism 25 .…”

“…The analysis of the preventability of ADRs was done according to the modified Schumock and Thornton scale. Out of the total ADRs received, it is evident that 57.83% of ADRs were Not Preventable,24.3% ADRs were Probably Preventable. Only 17.86% belonged to the Definitely Preventable group Fig.…”