Management of asparaginase induced hemorrhagic pancreatitis complicated by pseudocyst

Greenstein, Robert J.; Nogeire, Christopher; Ohnuma, Takao; Greenstein, Adrian J.

doi:10.1002/1097-0142(197902)43:2<718::aid-cncr2820430247>3.0.co;2-r

Cited by 36 publications

(14 citation statements)

References 19 publications

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“…Previous reports, however, suggest that L-Asp is the more likely source of pancreatitis based on histological examination of the pancreas, the relative infrequency of prednisone-induced pancreatitis, and a negative result after rechallenge with prednisone [3,5,6,8]. In addition, our results showed that the levels of trypsin and elastase-1 during prednisone therapy alone were not signi®cantly higher than those before L-Asp therapy.…”

Section: Discussionsupporting

confidence: 91%

“…There have been many reports of L-Asp-induced pancreatitis [4,5,10,13], but few studies have examined the relationship between L-Asp therapy and acute pancreatitis by measuring changes in serum levels of pancreatic enzymes [3,4]. Furthermore, there is no study that has evaluated the usefulness of trypsin and elastase-1 measurements in the diagnosis of L-Asp-induced pancreatitis.…”

Section: Discussioncontrasting

confidence: 68%

See 1 more Smart Citation

Increased serum trypsin and elastase-1 levels in patients undergoing L-asparaginase therapy

Shimizu

Yamashiro

Igarashi

et al. 1998

European Journal of Pediatrics

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LH:FSH ratio which return to normal under L-14 therapy are frequently observed in longstanding primary hypothyroidism and may account for the findings of precociaa puberty and cystic ovaries i n hypothy-roids (Lindsay et al, Am J Dis Child 134. 588. 1980). I n 10 congenital hypothyroid subjects aged 7 to 18 yrs (6 prepubertal girls and 4 pubertal boys). L-14 treatment uas discontinued for a 3reek period in order to perform thyroid scan. All of them underwent iv LH-RH-test immediately before and 20 days after the therapy uithdrawal All the blood samples were processed in the same run. The shifting of TSII. 74 and 13 serum values from the euthyroid to the hypothyroid range uas accompanied in all the patients by a significant increase in both baseline LH (12.9+4.7 vs 6.3+2.5 mIU/ml, 2 p < 0.001) and PRL (22.6+11.7 vs 11.6t3.0 ng1.l. 2 p<0.05) plasma levels On the contrary LH peak after LHRH (22.5+7.9 vs 20.1+10.4) and either basal (2.4: +1.5 vs 3.2+ 2.1 mIUIm1) or stimulated (7.9+2.0 vs 6.8:Z.O) FSH concentrations were not affected by L-14 withdrawal. These results indicate that: a) an evident increase in LH serum levels precociously occurs in response to thyroid failure; b) such increase does not reflect an enhanced sensitivity to LHRH; c) i t may reflect anomalous LH reactivity to I RH (Oe Luca et al, Ped Res 18, 1222. 1984) or abnormal clearance (Lindsay et al)., (I n t r o d. 104 by .. , t ,). D e p a r t n w t o f P e d i a t r i c s and d e p t. o f i n t e r n a l Medici-n e , Karolinska I n s t i t u t e t .ce w i t h r e s p e c t to o u t c m o f anti-thyroid drug therapy. Thirty-six c h i l d r e n (4 7 years) were diagnosed and t r e a t e d durinq 1972-1982. The m t e r i a l was c h a r a c t e r i z e d w i t h respxt t o sex, age, t i s s u e t y p e (HI&.-B8/DR3), t h y r o i d h o m n e v a l u e s , a u t o a n t i-bodies (TSH-receptor a n t i b d i e s , TRAK; microsamal and t h y r q l o b u-lin a n t i b o d i e s) and t h y r o i d fine-needle biopsy a t d i a g n o s i s. M e n p e r i o d o f a n t it h y r o i d therapy 33 m n t h s , man follow-up p e r i o d 67 m n t h s. 22 pat. (61%) have either r e l a p s e d f o l l o w i n g withdrawal o f a n t i t h y r o i d t r e a t m n t (17/36) o r have had t o undergo surgery because o f l a r g e g o i t e r and/or poor response to medication (5/36). The remaining 14 p a t. (39%) are still in remission. I n the r e l a p s e v s remission group the presence o f TRAK was 74% v s 18% and a lym-phocytic t h y r o i d i t i s a t biopsy 33% v s 64%. None o f the o t h e r factors examined a t d i a g n o s i s d i f f e r e d. At follow-up the m a t e r i a l was re-evaluated w i t h biopsy and autoantibodies. Evidence o f Hash* to's t h y r o i d i t i s (H) was found in six p a t i e n t s a l l i n remission. The other p a t. were c l a s s i f i e d a s Grave's d i s e a s e (G) and o n l y 8 (27%) were in remission. It is obvious t h a t there is a need f o r b e t t e r d i a g n o s t i c and prognostic t o o l s t o avoid long term t r...

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Section: Discussionsupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 68%

Increased serum trypsin and elastase-1 levels in patients undergoing L-asparaginase therapy

Shimizu

Yamashiro

Igarashi

et al. 1998

European Journal of Pediatrics

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“…Elevation in serum amylase and lipase are additional manifestation of pancreatitis. Complications that require surgical interventions are exceedingly rare; these include pancreatic pseudocysts [160,[163][164][165][166][167][168]. Some patients develop signs and symptoms of diabetes due to damage in islet cells, and subsequent decrease in synthesis of insulin.…”

Section: Toxicitymentioning

confidence: 99%

Pharmacological and clinical evaluation of l-asparaginase in the treatment of leukemia

Narta

Kanwar

Azmi

2007

Critical Reviews in Oncology/Hematology

333

229

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“…Although there have been many reports of ASNase-induced pancreatitis, [6,9,[12][13][14][15][16] few studies have examined the relationship between ASNase therapy and acute pancreatitis by measuring changes in serum levels of pancreatic enzymes or plasma levels of amino acids. [15,17,18] As in previous studies, [19,20] in the present study the plasma asparagine levels decreased rapidly after the first ASNase injection.…”

Section: Discussionmentioning

confidence: 99%

“…[23] Previous reports suggest that ASNase is the more likely source of pancreatitis on the basis of histologic examination of the pancreas, the relative infrequency of prednisolone-induced pancreatitis, and a negative result after rechallenge with prednisolone. [14,18,24] In the present study, one of 29 patients (3%) developed ASNase-induced pancreatitis, similar to the morbidity rates in previous reports. [4,6,9,16,25] Since the patient developed severe pancreatitis, ASNase was contraindicated during the rest of her treatment for ALL.…”

Section: Discussionmentioning

confidence: 99%

L-Asparaginase-Induced Pancreatic Injury is Associated with an Imbalance in Plasma Amino Acid Levels

et al. 2012

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Background: The use of L-asparaginase (ASNase) to modify amino acid metabolism is one of the most effective chemotherapeutic means of inducing remission in acute lymphoblastic leukemia (ALL). However, severe pancreatitis sometimes occurs in patients receiving ASNase, because of an unknown mechanism. Objective: The purpose of the present study was to evaluate the relationship between ASNase-induced pancreatic injury and plasma amino acid levels in patients undergoing ASNase therapy. Methods: A total of 29 children aged 1-13.25 years (median age 4 years; male : female ratio 19 : 10) with ALL, who received induction therapy according to the Tokyo Children's Cancer Study Group L04-16 protocol, were studied. Levels of plasma amino acids and serum rapid turnover proteins (RTPs), pancreatic enzymes, and pancreatic protease inhibitors were measured before and 1, 2, 3, 4, 5, and 7 weeks after the first administration of ASNase. Results: Plasma asparagine levels were significantly lower after the first injection of ASNase (p < 0.01) and had almost recovered 2 weeks after the last ASNase injection. At 4 weeks after the first ASNase injection, serum aspartic acid, trypsin, and pancreatic secretory trypsin inhibitor (PSTI) levels remained significantly higher than those before the first ASNase injection (p < 0.01), and serum levels of prealbumin and transferrin remained significantly lower than those before the first ASNase injection (p < 0.01). Plasma amino acid and serum RTP levels gradually normalized after the last ASNase injection. Conclusions: Levels of serum trypsin and PSTI were elevated during the 2 weeks after administration of ASNase, which suggested the presence of subclinical pancreatitis. This period is similar to the time period in the present

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Management of asparaginase induced hemorrhagic pancreatitis complicated by pseudocyst

Cited by 36 publications

References 19 publications

Increased serum trypsin and elastase-1 levels in patients undergoing L-asparaginase therapy

Increased serum trypsin and elastase-1 levels in patients undergoing L-asparaginase therapy

Pharmacological and clinical evaluation of l-asparaginase in the treatment of leukemia

L-Asparaginase-Induced Pancreatic Injury is Associated with an Imbalance in Plasma Amino Acid Levels

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