PEG-asparaginase induced severe hypertriglyceridemia

Abstract

SUMMARYAsparaginase (ASP) is an effective chemotherapy agent extensively used in children with acute lymphocytic leukemia (ALL). There has been a recent interest in using ASP in adults with ALL, particularly the less toxic pegylated (PEG) formulation. Hypertriglyceridemia (HTG) is a rare complication of PEG-ASP therapy. We report two cases of obese patients who developed severe HTG after receiving PEG for ALL. Both patients were incidentally found to have severe HTG (TG of 4,330 and 4,420 mg/dL). In both patients, there was no personal or family history of dyslipidemia or hypothyroidism. There was no evidence of pancreatitis or skin manifestations of HTG. Both patients were treated with PEG cessation, low-fat diet and pharmacotherapy. Both patients were re-challenged with PEG, with subsequent increase in TG but no associated complications. TG returned to baseline after discontinuing PEG and while on therapy for HTG. A literature review of PEG-induced HTG in adults demonstrated similar results: asymptomatic presentation despite very severe HTG. HTG is a rare but clinically important adverse effect of PEG. Underlying obesity and/or diabetes may represent risk factors. Clinicians should monitor TG levels during PEG therapy to avoid TG-induced pancreatitis. Arch Endocrinol Metab. 2016;60(2):173-7

Pegaspargase-induced hypertriglyceridemia in a patient with acute lymphoblastic leukemia

“…Pharmacological treatment of HTG. 12,35,36 and obese patients were more likely to develop severe HTG, however, the difference was not statistically significant. 4…”

“…Reducing dietary fat and simple carbohydrates are a first line recommendation for HTG. 12,35 Other therapeutic strategies include an insulin infusion, heparin infusion, or plasmapheresis. 12 Three pharmacological classes are available for HTG treatment: fibrates, niacin, and omega-3 fatty acids ( Table 3).…”

“…12,35 Other therapeutic strategies include an insulin infusion, heparin infusion, or plasmapheresis. 12 Three pharmacological classes are available for HTG treatment: fibrates, niacin, and omega-3 fatty acids ( Table 3). Fibrates such as gemfibrozil and fenofibrate are recommended as first-line therapy, especially for triglyceride-induced pancreatitis.…”

Non-alcoholic fatty liver disease is associated with early left ventricular dysfunction in childhood acute lymphoblastic leukaemia survivors

“…As BMI was not different between patients and controls, we argue that this finding is likely related to changes in lifestyle, with reduced physical activity (3, 4), but we cannot exclude that the treatment with antineoplastic agents partially account for the fat accumulation. In fact treatment of ALL, beyond its acknowledged effect on IR, has been reported to cause derangement of lipid profile, in particular during steroids and asparaginase administration (59,60,61), and even though this toxic effect seems to be transient, long-term follow-up of patients with history of severe hypertriglyceridemia is recommended to better understand additional therapy-related risk factors for the development of MetS and CVD (60). The patients with NAFLD presented lower HDL cholesterol and higher indexes of adiposity (BMI, waist circumference/height ratio, subcutaneous and peritoneal fat) and IR than those with normal liver, and these factors are clustered in the definition of MetS.…”

Living with hematologic cancer: Recommendations, solutions

“…Survivors are also at risk of secondary cancers and recurrence of the primary cancer. [8][9][10][11][12][13][14][15] Despite the gravity of a cancer diagnosis, cancer patients do not always adhere to a healthy lifestyle. A survey of over 400,000 cancer survivors found that 15% were current cigarette smokers, 27.5% were obese, and 31.5% had not engaged in physical activity during the previous 30 days.…”