10 Abnormal Glucose Tolerance in Children With Acute Lymphoblastic Leukemia (All): The Effect of Induction Chemotherapy

Dacou-Voutetokis, C; Haidas, S; Georgiopoulou, P.; Palis, James; Zannos-Mariolea, L.; Matsaniotis, N

doi:10.1203/00006450-197908000-00026

Cited by 3 publications

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“…The self‐resolving nature of TH might contribute to a belief that it should not be a source of concern. However, previous reports have noted significant morbidity as a result of TH, ranging from the need for insulin therapy to diabetic ketoacidosis 2–11. There is evidence in adults with ALL that hyperglycemia may be associated with decreased time to relapse and decreased overall survival 17.…”

Section: Discussionmentioning

confidence: 99%

“…Hyperglycemia is a common side effect of acute lymphoblastic leukemia (ALL) therapy. It has long been recognized as a consequence of corticosteroids (either prednisone or dexamethasone) and asparaginase, chemotherapeutic agents key to ALL treatment 1–10. These medications are usually administered concurrently in high doses during the initial induction phase of chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the Prognostic Value of Peak Creatine Kinase‐MB and Troponin Levels Among Patients With Acute Myocardial Infarction: A Report from the Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With The Guidelines

Chin

Wang

et al. 2012

Clinical Cardiology

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Background:Although peak creatine kinase‐myocardial band (CK‐MB) and troponin levels have been correlated with mortality among patients with acute myocardial infarction (AMI), the independent prognostic implications of these markers have not been compared.Hypothesis:We hypothesized that in patients with AMI, peak troponin levels (as compared to peak CK‐MB levels) would have greater prognostic value.Methods:We examined AMI patients in the National Cardiovascular Data Registry ACTION Registry–GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With The Guidelines) with CK‐MB and troponin I levels recorded, excluding patients who were transferred in or out. Peak marker levels, standardized by the local laboratory upper limit of normal and assay standard deviation, were fitted into the previously validated ACTION Registry–GWTG mortality model to compare prognostic value.Results:Between January 2007 and March 2009, 16 009 ST‐segment elevation myocardial infarction (STEMI) and 26854 non–ST‐segment elevation myocardial infarction (NSTEMI) patients were identified. Peak marker ratios were directly associated with in‐hospital mortality in both STEMI and NSTEMI patients. Peak CK‐MB had slightly greater discrimination compared with peak troponin I in predicting mortality in both STEMI (model C‐statistic 0.881 vs 0.877, P = 0.011) and NSTEMI (C‐statistic 0.831 vs 0.824, P = 0.001) patients.Conclusions:Both peak CK‐MB and peak troponin I levels are independently associated with in‐hospital mortality in this large contemporary database of AMI patients treated in routine practice. Peak marker values slightly improved model performance in prognosticating in‐hospital mortality; the incremental value was higher with CK‐MB than with troponin I. These findings may help to guide future risk stratification algorithms and contribute to more efficient use of serial cardiac marker measurements in clinical practice. Clin. Cardiol. 2011 DOI: 10.1002/clc.21980This project was supported by grant number U18HS016964 from the Agency for Healthcare Research and Quality (AHRQ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ. The funding source had no role in the design or implementation of the study, or in the decision to seek publication. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of the Prognostic Value of Peak Creatine Kinase‐MB and Troponin Levels Among Patients With Acute Myocardial Infarction: A Report from the Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With The Guidelines

Chin

Wang

et al. 2012

Clinical Cardiology

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“…Main pancreatic duct appears normal. Minimal fat stranding was also noted [10,[13][14][15]. Risk factors for hyperglycemia during ALL therapy include age > 10 years, obesity, down's syndrome, use of prednisolone and/or L-asparaginase [12].…”

Section: Discussionmentioning

confidence: 96%

Concurrent diabetic ketoacidosis and pancreatitis in Paediatric acute lymphoblastic leukemia receiving L-asparaginase

et al. 2020

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Background Although hyperglycemia and pancreatitis are known side effects of L-asparaginase, both contributing to the development of diabetic ketoacidosis (DKA) is unfamiliar in literature. Case presentation We report a case of an adolescent girl, recently diagnosed with ALL, who presented with pain in abdomen and breathing difficulty following chemotherapy with L-asparaginase. On subsequent evaluation, she was found to have high anion gap metabolic acidosis, hyperglycemia and ketonuria. Ultrasonogram showed bulky pancreas. DKA was managed with fluid correction and insulin infusion. Pancreatitis was managed conservatively. She recovered completely with resolution of symptoms and without any major adverse events despite having such severe complications. Conclusion We conclude that the combination of DKA and pancreatitis is a rare occurrence with significant morbidity and mortality. We recommend a close monitoring of blood glucose levels for hyperglycemia as well as a high index of clinical suspicion for pancreatitis in patients with ALL receiving L-asparaginase.

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“…Occurrence of DIDM during ALL therapy has been mainly attributed to drugs like corticosteroids and l -asparaginase 8–10. However, the diabetogenic effect of the leukemic process affecting glucose homeostasis has also been hypothesized to cause DIDM in ALL patients.…”

Section: Methodsmentioning

confidence: 99%

Drug Induced Diabetes Mellitus in Pediatric Acute Lymphoblastic Leukemia: Approach to Diagnosis and Management

Handattu¹,

Sharma

Vijayasekharan

et al. 2022

Journal of Pediatric Hematology/Oncology

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Corticosteroids and L-asparaginase used in the treatment of pediatric acute lymphoblastic leukemia (ALL) can cause drug-induced diabetes mellitus (DIDM). DIDM can lead to dyselectrolytemia, a higher risk of infections including cellulitis, bacteremia, fungemia, and a higher incidence of febrile neutropenia and may have an impact on the outcome of ALL. Literature on the management of DIDM among children with ALL is sparse and the diagnostic criteria for pediatric diabetes should be carefully applied considering the acute and transient nature of DIDM during ALL therapy. Insulin remains the standard of care for DIDM management and the choice of Insulin regimen (standalone Neutral Protamine Hagedorn or basal bolus) should be based on the type and dose of steroids used for ALL and the pattern of hyperglycemia. A modest glycemic control (postmeal 140 to 180 mg/ dL, premeal <140 mg/dL) to prevent complications of hyperglycemia, as well as hypoglycemia, would be the general approach. This review is intended to suggest evidence-based practical guidance in the diagnosis and management of DIDM during pediatric ALL therapy.

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10 Abnormal Glucose Tolerance in Children With Acute Lymphoblastic Leukemia (All): The Effect of Induction Chemotherapy

Cited by 3 publications

References 0 publications

Comparison of the Prognostic Value of Peak Creatine Kinase‐MB and Troponin Levels Among Patients With Acute Myocardial Infarction: A Report from the Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With The Guidelines

Comparison of the Prognostic Value of Peak Creatine Kinase‐MB and Troponin Levels Among Patients With Acute Myocardial Infarction: A Report from the Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With The Guidelines

Concurrent diabetic ketoacidosis and pancreatitis in Paediatric acute lymphoblastic leukemia receiving L-asparaginase

Drug Induced Diabetes Mellitus in Pediatric Acute Lymphoblastic Leukemia: Approach to Diagnosis and Management

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