Frequency of Asparaginase-Associated Pancreatitis in Patients Presenting with Acute Lymphoblastic Leukemia and Lymphoblastic Lymphoma
DOI:
https://doi.org/10.70749/ijbr.v3i4.2500Keywords:
Asparaginase, Acute lymphoblastic leukemia, Lymphoblastic lymphoma, Pancreatitis, Chemotherapy-related toxicity.Abstract
Background: L-asparaginase is a vital component of chemotherapy protocols for acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL), significantly improving remission and survival rates. However, its use is associated with serious adverse effects, including asparaginase-associated pancreatitis (AAP), which can interrupt treatment and increase morbidity. The reported incidence of AAP varies from 2.5% to 16% globally, but local data among young adults are limited. This study aimed to determine the frequency of AAP in young adults diagnosed with ALL and LBL at a tertiary care cancer hospital in Pakistan. Methods: A cross-sectional study was conducted at the Department of Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, over six months following synopsis approval. One hundred patients aged 16–25 years with confirmed diagnoses of ALL or LBL were enrolled through non-probability consecutive sampling. Results: The mean age of participants was 20.6 ± 2.8 years, with 55% males and 45% females. Eighty-five percent were diagnosed with ALL and 15% with LBL. Asparaginase-associated pancreatitis was identified in seven patients (7%). No significant associations were observed between AAP and age, gender, WBC count, disease duration, or duration of asparaginase therapy (p > 0.05). Overall mortality was 5%, including one patient with pancreatitis. Conclusion: The frequency of asparaginase-associated pancreatitis in young adults with ALL and LBL was 7%, aligning with international data. Routine biochemical and radiological monitoring during chemotherapy is recommended for early detection and timely management to reduce treatment-related morbidity.
Downloads
References
1. Skipper MT, Birkebæk N, Jensen RB, Rank CU, Tuckuviene R, Wehner PS, et al. Pancreas‐related persisting sequelae in ALL survivors with a history of asparaginase‐associated pancreatitis: A part of the ALL‐STAR study. European Journal of Haematology. 2024;112(6):944-56.
https://doi.org/10.1111/ejh.14189
2. Lin L, Yang K-H, Chen C-C, Shen S-H, Hu W-T, Deng Z-H. Risk factors and a prediction model of severe asparaginase-associated pancreatitis in children. Annals of Hematology. 2025;104(2):1015-22.
https://doi.org/10.1007/s00277-024-06133-9
3. Hassan S, Ahmed S, Ali N, Mokhles A, Zaky I, Reda H, et al. Risk factors and outcome of asparaginase-associated pancreatitis in pediatric acute lymphoblastic leukemia. Frontiers in Oncology. 2025; 15:1606261.
https://doi.org/10.3389/fonc.2025.1606261
4. Kurtipek FB, Damar Ç, Gökçek E, Gülhan B, Azili MN, Yarali N. Rare Pancreatitis-related Complications of L-Asparaginase in Pediatric Acute Lymphoblastic Leukemia: A Case With Pseudocyst and Panniculitis and Literature Review. Journal of Pediatric Hematology/Oncology. 2025;47(7):e339-e44.
https://doi.org/10.1097/mph.0000000000003110
5. Andrés-Jensen L, Nielsen CG, van den Heuvel-Eibrink MM, Schmiegelow K. Acute Toxicity and Late Effects Related to Acute Lymphoblastic Leukemia Treatment. Acute Lymphoblastic Leukemia in Children and Adolescents: Springer; 2024. p. 279-303.
https://doi.org/10.1007/978-3-031-71180-0_18
6. Heenan JM, Hooper AJ, Burnett JR, Cooney J. l-asparaginase-induced biochemical toxicities in young adults with acute lymphoblastic leukaemia and T-lymphoblastic lymphoma. Pathology. 2021;53(7):924-6.
https://doi.org/10.1016/j.pathol.2021.02.015
7. M'harzi S, Elouali A, Lahrache K, Ghanam A, Babakhouya A, Rkain M, et al. Acute pancreatitis following L-asparaginase in acute lymphoblastic leukemia. Leukemia Research Reports. 2022; 18:100357.
https://doi.org/10.1016/j.lrr.2022.100357
8. Schmidt M-P, Ivanov A-V, Coriu D, Miron I-C. L-asparaginase toxicity in the treatment of children and adolescents with acute lymphoblastic leukemia. Journal of Clinical Medicine. 2021;10(19):4419.
https://doi.org/10.3390/jcm10194419
9. Christ TN, Stock W, Knoebel RW. Incidence of asparaginase-related hepatotoxicity, pancreatitis, and thrombotic events in adults with acute lymphoblastic leukemia treated with a pediatric-inspired regimen. Journal of Oncology Pharmacy Practice. 2018;24(4):299-308.
https://doi.org/10.1177/1078155217701291
10. Nguyen HTK, Terao MA, Green DM, Pui CH, Inaba H. Testicular involvement of acute lymphoblastic leukemia in children and adolescents: Diagnosis, biology, and management. Cancer. 2021;127(17):3067-81.
https://doi.org/10.1002/cncr.33609
11. Morawiak A, Salamonowicz-Bodzioch M, Królak A, Kałwak K, Owoc-Lempach J, Kowalczyk J, et al. Acute pancreatitis in pediatric acute lymphoblastic leukemia (AcuPA study): a nationwide survey in Poland. Cancers. 2024;16(15):2640.
https://doi.org/10.3390/cancers16152640
12. Maese L, Rau RE. Current use of asparaginase in acute lymphoblastic leukemia/lymphoblastic lymphoma. Frontiers in Pediatrics. 2022; 10:902117.
https://doi.org/10.3389/fped.2022.902117
13. Chen C-B, Chang H-H, Chou S-W, Yang Y-L, Lu M-Y, Jou S-T, et al. Acute pancreatitis in children with acute lymphoblastic leukemia correlates with L-asparaginase dose intensity. Pediatric Research. 2022;92(2):459-65.
https://doi.org/10.1038/s41390-021-01796-w
14. Gibson A, Hernandez C, Tejada FNH, Kawedia J, Rytting M, Cuglievan B. Asparaginase-associated pancreatitis in pediatric patients with acute lymphoblastic leukemia: current perspectives. Pediatric Drugs. 2021;23(5):457-63.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Indus Journal of Bioscience Research
This work is licensed under a Creative Commons Attribution 4.0 International License.
