A Case Report of an Adult With Severe Hyperlipidemia During Acute Lymphocytic Leukemia Induction Therapy Successfully Treated With Plasmapheresis

Abstract

Plasmapheresis for the treatment of hypertriglyceridemia has previously been performed in patients with sudden onset severe hypertriglyceridemia and acute pancreatitis; however, only a few reports of this procedure have been published. We report here on a case showing severe hypertriglyceridemia during asparaginase (Asp) treatment for acute lymphocytic leukemia (ALL), and give an overview of a lipid-lowering apheresis therapy. To prevent the complication of pancreatitis due to hypertriglyceridemia, we performed plasma exchange (PE) three times using fresh frozen plasma. PE remarkably reduced both serum triglyceride and total cholesterol levels from 5430 mg/dL to 403 mg/dL and from 623 mg/dL to 204 mg/dL, respectively. The causes of severe hyperlipidemia in this patient were considered to include: the Asp treatment for ALL, and a genetic background with a heterozygote of familial lipoprotein lipase (LPL) defect syndrome, because the patient's plasma LPL level after intravenous heparin injection was low at 137 ng/mL. Hence, PE using fresh frozen plasma may be useful not only to remove lipoproteins, but also to supply defective factors, such as LPL, in similar cases.

PEG-asparaginase induced severe hypertriglyceridemia

“…Heparin infusion is indicated in patients with thrombosis and may help to improve the transient ASP-induced HTG state (19). Plasmapheresis is another costlier option that has also been successfully used in patients with severe HTG (TG > 2,000 mg/dL) and HTG-induced pancreatitis (9,11). Our study is limited by its retrospective nature.…”

“…ASP-related toxicity includes: pancreatitis, liver toxicity, thrombosis, hyperglycemia, hypersensitivity reactions, hyperviscosity syndrome, osteonecrosis and lipemia retinalis (1)(2)(3). Asymptomatic hypertriglyceredemia (HTG) has also been reported (4,5) but with just few case reports in adults (6)(7)(8)(9)(10)(11)(12)(13). Here, we describe two adults with asymptomatic PEGassociated severe HTG and provide the first literature review of adults with PEG-induced HTG.…”

Plasmapheresis in the Management of Severe Hypertriglyceridemia

“…TPE has been effective in acute management of patients with hypertriglyceridemic pancreatitis and acute respiratory distress syndrome, 30 recurrent acute pancreatitis, 29 diabetes-associated severe hypertriglyceridemia, 31 gestational hypertriglyceridemia, 32 and familial hyperlipidemias. 33 In one case, 31 plasmapheresis was used successfully in a child with hypertriglyceridemia, diabetic ketoacidosis, pancreatitis, and acute kidney injury. TPE is also an effective treatment in hypertriglyceridemia associated with ritonavir 34 and with asparaginase chemotherapy for acute lymphocytic anemia in adults and children.…”

“…TPE is also an effective treatment in hypertriglyceridemia associated with ritonavir 34 and with asparaginase chemotherapy for acute lymphocytic anemia in adults and children. 33,35,36 In addition to using TPE, clinicians should treat the underlying cause of the hypertriglyceridemia, which may include diabetes (as in our case), excessive alcohol consumption, and pancreatitis. In our case, a plan of care was created to correct the underlying cause of hypertriglyceridemia, that is, type 2 diabetes mellitus.…”

Cholesterol and Triglycerides Metabolism Disorder in Malignant Hemopathies

“…A child heterozygote for apolipoprotein E 3/4 and with ALL who received pegasparaginase, presented an important aumentation of serum TG value, which normalized after continuous insulin infusion (Lawson et al, 2011). Another patient with a heterozygote type of familial lipoprotein lipase defect syndrome developed an important increase of serum TG value that was treated by three plasma exchanges with frozen plasma (Nakagawa et al, 2008). An adult patient with ALL also had an acute pancreatitis because of an important hypertriglyceridemia that appeared after asparaginase administration (Kfoury-Baz et al, 2008), as well as a 10 years old boy who had been previously treated with asparaginase and corticosteroids (Ridola et al, 2008), both successfully treated by plasmapheresis sessions (Kfoury-Baz et al, 2008;Ridola et al, 2008).…”