Lipid Apheresis to Manage Severe Hypertriglyceridemia during Induction Therapy in a Child with Acute Lymphoblastic Leukemia

Mayerhofer, Christina; Speckmann, Carsten; Kapp, Friedrich; Teufel-Schäfer, Ulrike; Kluwe, Wolfram; Schneider, Johanna; Flotho, Christian

doi:10.1080/08880018.2020.1756999

Cited by 4 publications

(2 citation statements)

References 23 publications

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“…Reported treatment options range from dietary restrictions, fibrates, insulin infusions, statins, heparin infusion, omega‐3 fatty acids, omission of dexamethasone, and plasmapheresis (Supporting Information Table S7). 10,11,37–47 In this review, we included one small randomized trial suggesting that omega‐3 fatty acids prevent or delay the development of dyslipidemia during ALL treatment, 33 which is in line with previous nonrandomized studies 28,41 . A preclinical animal study reported that hypertriglyceridemia in mice was successfully managed by fenofibrate and was associated with reductions in osteonecrosis 48 .…”

Section: Discussionmentioning

confidence: 67%

Hyperlipidemia in children and adolescents with acute lymphoblastic leukemia: A systematic review and meta‐analysis

Laumann,

Pedersen,

Andrés‐Jensen

et al. 2023

Pediatric Blood & Cancer

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BackgroundThe established association between acute lymphoblastic leukemia (ALL) and hyperlipidemia has, in some studies, been linked to toxicities such as pancreatitis, thrombosis, and osteonecrosis. However, a systematic review investigating the incidence, management, and clinical implications of hyperlipidemia during childhood ALL treatment is lacking.ObjectivesSystematically assess the incidence of hyperlipidemia during ALL treatment, explore associations with risk factors and severe toxicities (osteonecrosis, thrombosis, and pancreatitis), and review prevalent management strategies.MethodsA systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement. Data synthesis was descriptive, and a meta‐analysis of hypertriglyceridemia and risk of severe toxicities was performed.ResultsWe included 13 studies with 3,425 patients. Hyperlipidemia incidence varied widely (6.7%‐85%) but with inconsistent definitions and screening strategies across studies. Evidence regarding risk factors was conflicting, but age (> 10 years) and treatment with asparaginase and glucocorticosteroids seem to be associated with hyperlipidemia. Hypertriglyceridemia (grade 3/4) increased the risk for osteonecrosis (odds ratio (OR): 4.27, 95% confidence interval (CI): 2.77‐6.61). No association could be established for pancreatitis (OR: 1.60, 95% CI: 0.53‐4.82) or thrombosis (OR: 2.45, 95% CI: 0.86‐7.01), but larger studies are needed to confirm this.ConclusionThe overall evidence of this systematic review is limited by the small number of studies and risk of bias. Our review suggests that hypertriglyceridemia increases the risk for osteonecrosis. However, larger studies are needed to explore the clinical implications of hyperlipidemia and randomized trials investigating hyperlipidemia management and its impact on severe toxicities.

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Section: Discussionmentioning

confidence: 67%

Hyperlipidemia in children and adolescents with acute lymphoblastic leukemia: A systematic review and meta‐analysis

Laumann,

Pedersen,

Andrés‐Jensen

et al. 2023

Pediatric Blood & Cancer

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“…Its antitumor effect results from the depletion of asparagine, an amino acid essential to leukemic cells, and the subsequent inhibition of protein synthesis, leading to considerable cytotoxicity. In pediatric studies, triglycerides (TG) were affected more by PEG‐asparaginase than by native L‐asparaginase (10.5% vs. 5.5%) [ 1 , 2 , 3 , 4 ]. The true incidence of hypertriglyceridemia in adults treated with PEG‐asparaginase as part of a pediatric‐inspired asparaginase regimen is not exactly known.…”

Section: Introductionmentioning

confidence: 99%

Safety of re‐challenging adults with acute lymphoblastic leukemia with PEG‐asparaginase‐induced severe hypertriglyceridemia when treated with a pediatric‐inspired regimen

Nabhani

Andrews

Sibai

et al. 2022

eJHaem

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PEG-asparaginase is used as a treatment for Philadelphia-negative acute lymphoblastic leukemia. In pediatric studies, triglycerides (TGs) were affected more by PEG-asparaginase than by native L-asparaginase (10.0% vs. 5.5%). We conducted a retrospective study to determine the safety of re-challenging adult patients with PEG-asparaginase after experiencing an episode of severe hypertriglyceridemia (>1000 mg/dl or 11.4 mmol/L). The incidence of hypertriglyceridemia associated with PEG-asparaginase in adult patients was high (67.5%). Therefore, checking TGs at baseline and monitoring levels while receiving PEG-asparaginase need to be considered and studied in prospective studies. However, in patients with hypertriglyceridemia not complicated by acute pancreatitis, re-challenging is safe once TG levels normalize.

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Chemotherapy/pegaspargase/prednisolone

2020

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Lipid Apheresis to Manage Severe Hypertriglyceridemia during Induction Therapy in a Child with Acute Lymphoblastic Leukemia

Cited by 4 publications

References 23 publications

Hyperlipidemia in children and adolescents with acute lymphoblastic leukemia: A systematic review and meta‐analysis

Hyperlipidemia in children and adolescents with acute lymphoblastic leukemia: A systematic review and meta‐analysis

Safety of re‐challenging adults with acute lymphoblastic leukemia with PEG‐asparaginase‐induced severe hypertriglyceridemia when treated with a pediatric‐inspired regimen

Chemotherapy/pegaspargase/prednisolone

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