Pancreas‐related persisting sequelae in ALL survivors with a history of asparaginase‐associated pancreatitis: A part of the ALL‐STAR study

Abstract

ObjectivesAsparaginase‐associated pancreatitis (AAP) occurs in up to 18% of patients treated for acute lymphoblastic leukemia (ALL); however, long‐term sequelae are largely unexplored. We aimed to explore pancreatic sequelae among ALL survivors with and without AAP.MethodsWe investigated pancreatic sequelae in a national cohort of ALL survivors, aged 1–45 years at ALL diagnosis treated according to the NOPHO‐ALL2008 protocol and included sex‐ and age‐matched community controls.ResultsWe included 368 survivors (median follow‐up 6.9 years), including 47 survivors with AAP and 369 controls. The p‐lipase and p‐pancreas‐type amylase levels were lower in AAP survivors compared with both non‐AAP survivors (Medians: 23 U/L [IQR 14–32] and 18 U/L [IQR 10–25] versus 29 [IQR 24–35] and 22 [17–28], p < .001 and p = .002) and community controls (28 U/L [IQR 22–33] and 21 U/L [IQR 17–26], both p < .006). Fecal‐elastase was more frequently reduced in AAP survivors compared with non‐AAP survivors (7/31 vs. 4/144, p = .001). Persisting pancreatic sequelae were found in 15/47 of AAP survivors and 20/323 of non‐AAP survivors (p < .001), including diabetes mellitus in 2/39 of AAP survivors and 2/273 of non‐AAP survivors.ConclusionsALL survivors with AAP are at increased risk of persisting pancreatic dysfunction and require special attention during follow‐up.