Insulin Infusion to Treat Severe Hypertriglyceridemia Associated With Pegaspargase Therapy

Abstract

We describe a pediatric patient with acute leukemia who developed an uncommon but significant metabolic consequence of pegaspargase therapy-severe hypertriglyceridemia (hyperTG). We also relate our experience with continuous insulin infusion treatment for pegaspargase-induced hyperTG. This treatment approach led to a decrease in triglycerides from 4640 mg/dL on admission to 522 mg/dL at discharge 9 days later. Genetic testing revealed that our patient was an apolipoprotein E 3/4 heterozygote. Our review of the literature suggests that apolipoprotein E polymorphism may influence the development of hyperlipidemia in acute lymphoblastic leukemia patients receiving asparaginase therapy and may identify patients at high risk for developing asparaginase-induced hyperTG.

Severe hypertriglyceridaemia during therapy for childhood acute lymphoblastic leukaemia

“…Occasionally, life-threatening emergencies have warranted plasmapheresis [15]. However, for asymptomatic patients or in those with milder symptoms, therapy has ranged from observation and dietary modification alone, [13] to steroid omission, [14] or pharmacotherapy with omega-3 fatty acids (FA), [16] fibrates, [12] statins, [17] heparin [12] or insulin [18]. …”

Case Report: The Use of Intravenous SMOFlipid Infusion to Treat Severe Asparaginase-Induced Hypertriglyceridemia in Two Pediatric Acute Lymphoblastic Leukemia Patients

“…There are currently no standard treatment guidelines for asparaginaseinduced hypertriglyceridemia in pediatric patients with ALL. Isolated case reports and small reviews have suggested several approaches, namely short-term fasting or low-fat diet, oral fibrates, oral omega-3 fatty acids, and insulin infusion (7,10,12,13). Plasmapheresis has been shown to be effective in reducing TG levels rapidly after 2 h of apheresis (9); clinical improvement was seen as early as 8 h and normalization of the TG levels was achieved after 72 h of plasmapheresis (3).…”

Utilidad de la plasmaféresis en la pancreatitis aguda por hipertrigliceridemia

“…Dentro de las opciones dirigidas, se encuentra la administración de insulina (17), que promueve el almacenamiento de glucosa y de ácidos grasos, así como estimula comitante el HDL en cerca del 5 %. Por lo tanto, se infiere la pertinencia de la prescripción ambulatoria de estos ácidos en caso de que los fibratos se encuentren contraindicados) (30-32) (Tabla 5).…”