The Effect of Combination of Steroid and L-Asparaginase on Hyperglycemia in Children with Acute Lymphoblastic Leukemia (ALL)

Aisyi, Mururul; Andriastuti, Murti; Kurniati, Nia

doi:10.31557/apjcp.2019.20.9.2619

Cited by 14 publications

(12 citation statements)

References 29 publications

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“…14 A study reported that the incidence of hyperglycemia as a side effect of steroid and L-Asp combination was 5.2%, from three centers in Indonesia. 15 We found that 6 subjects (16.6%) experienced hyperglycemia when they received prednisone as well as L-Asp simultaneously during the induction phase, with fasting BG ranging from 130 mg/dL to 311 mg/dL , and 329 mg/dL in one episode of two-hour postprandial BG. Native L-Asp, on the contrary, was reported to result in more hypoglycemia than hyperglycemia during chemotherapy in childhood ALL.…”

Section: Discussionmentioning

confidence: 76%

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: 76%

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

Andria¹,

Moelyo²,

Reza³

2020

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“…In the study by Aisyi et al only 5.2% of the respondents were diagnosed with hyperglycemia caused by dexamethasone in combination with L-asparaginase [16].…”

Section: Adherence To Dietary Recommendations By Children and Adolescmentioning

confidence: 92%

“…W badaniu przeprowadzonym przez Aisyi i wsp. tylko 5,2% badanych miało stwierdzoną hiperglikemię spowodowaną przez deksametazon w połączeniu z L-asparaginazą [16].…”

Section: Dyskusjaunclassified

Adherence to dietary recommendations by children and adolescents during steroid therapy in acute lymphoblastic leukemia

Hadaś

Stefanowicz

2020

Pielegniarstwo XXI Wieku / Nursing in the 21st Century

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Aim. Assessment of adherence to dietary recommendations by children and adolescents during steroid therapy in the treatment of acute lymphoblastic leukemia (ALL).Material and methods. The study was conducted among parents of children with ALL, aged from 1 to 17 years, treated at the Department of Paediatrics, Hematology and Oncology of the University Clinical Centre in Gdańsk. The paper uses the method of a diagnostic survey, the questionnaire technique. The research tool was an anonymous self-constructed questionnaire.Results. The study included 16 parents (44.4%) of female children and 20 parents (55.6%) of male children. Normal body weight was found in most of the children (22/36 children). Grade 1 hypertension was found in 15/36 children and grade 2 hypertension in 6/36. In 31/36 children, the blood glucose level was 70-180 mg%. The number of 22/36 examined children used a diet with a low glycemic index. As many as 29/36 parents of children and adolescents with ALL followed the diet recommended by a doctor.Conclusions. 1) Most children with ALL have normal body weight during steroid therapy. 2) Children with ALL are subject to arterial hypertension during steroid therapy. 3) Most parents or legal guardians of children and adolescents with ALL adhered to dietary recommendations during steroid therapy.

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“…GIH is a phenomenon that typically occurs acutely with initiation[ 85 , 87 , 90 , 91 ], and hyperglycemia was found to be significant by day 2 in those being treated systemically for hematologic malignancies[ 11 ]. The degree of glucose elevations range widely and are most frequently modest (< 14 mmol/L)[ 92 ], nonetheless severe hyperglycemia (> 28 mmol/L) and DKA have also been reported[ 11 , 93 ], with rare reports of hyperglycemic hyperosmolar syndrome as well[ 94 ]. Other AE associated with GIH range from mild to serious, such as increased infections and lengthened of hospital stays[ 11 , 16 , 86 , 95 - 98 ].…”

Section: Glucocorticoidsmentioning

confidence: 99%

“…Prednisone levels peak 4-8 h after ingestion and its duration of action is between 12 h to 16 h; these pharmacokinetics correlated with increases in postprandial glucose in the afternoon and evening when administered in the morning[ 11 , 87 , 92 ]. During induction therapy for acute lymphoblastic leukemia the use of long-lasting dexamethasone was linked with a significant increase in risk of GIH when compared to those prescribed the intermediate-acting prednisone[ 93 ]. In contrast, a comparison between dexamethasone 8-12mg IV and prednisone 40mg orally found extensive hyperglycemia in the majority of all patients, without differences between the two therapies[ 94 ].…”

Section: Glucocorticoidsmentioning

confidence: 99%

Current cancer therapies and their influence on glucose control

Yim¹,

Mansell²,

Hussein³

et al. 2021

WJD

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This review focuses on the development of hyperglycemia arising from widely used cancer therapies spanning four drug classes. These groups of medications were selected due to their significant association with new onset hyperglycemia, or of potentially severe clinical consequences when present. These classes include glucocorticoids that are frequently used in addition to chemotherapy treatments, and the antimetabolite class of 5-fluorouracil-related drugs. Both of these classes have been in use in cancer therapy since the 1950s. Also considered are the phosphatidyl inositol-3-kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR)-inhibitors that provide cancer response advantages by disrupting cell growth, proliferation and survival signaling pathways, and have been in clinical use as early as 2007. The final class to be reviewed are the monoclonal antibodies selected to function as immune checkpoint inhibitors (ICIs). These were first used in 2011 for advanced melanoma and are rapidly becoming widely utilized in many solid tumors. For each drug class, the literature has been reviewed to answer relevant questions about these medications related specifically to the characteristics of the hyperglycemia that develops with use. The incidence of new glucose elevations in euglycemic individuals, as well as glycemic changes in those with established diabetes has been considered, as has the expected onset of hyperglycemia from their first use. This comparison emphasizes that some classes exhibit very immediate impacts on glucose levels, whereas other classes can have lengthy delays of up to 1 year. A comparison of the spectrum of severity of hyperglycemic consequences stresses that the appearance of diabetic ketoacidosis is rare for all classes except for the ICIs. There are distinct differences in the reversibility of glucose elevations after treatment is stopped, as the mTOR inhibitors and ICI classes have persistent hyperglycemia long term. These four highlighted drug categories differ in their underlying mechanisms driving hyperglycemia, with clinical presentations ranging from potent yet transient insulin resistant states [type 2 diabetes mellitus (T2DM) -like] to rare permanent insulin-deficient causes of hyperglycemia. Knowledge of the relative incidence of new onset hyperglycemia and the underlying causes are critical to appreciate how and when to best screen and treat patients taking any of these cancer drug therapies.

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The Effect of Combination of Steroid and L-Asparaginase on Hyperglycemia in Children with Acute Lymphoblastic Leukemia (ALL)

Cited by 14 publications

References 29 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

Adherence to dietary recommendations by children and adolescents during steroid therapy in acute lymphoblastic leukemia

Current cancer therapies and their influence on glucose control

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