RETRACTED: Peg-Asparaginase-Associated Pancreatitis in Chemotherapy-Treated Pediatric Patients: A 5-Year Retrospective Study

Abstract

Background: Asparaginase-associated pancreatitis (AAP) is one of the most common complications occurring in patients with asparaginase-treated acute lymphoblastic leukemia (ALL). Peg-asparaginase (peg-asp), a chemically recombined asparaginase with lower hyposensitivity and better patient tolerance, is now approved as the first line asparaginase formulation in ALL chemotherapy regimens. Due to the differences in pharmacokinetic characteristics and administration procedure between l-asp and peg-asp, this study aimed to investigate the clinical manifestations of peg-asp-associated pancreatitis. Method: Patients with peg-asp-associated pancreatitis diagnosed within a 5-year period (July 2014 to July 2019) were identified and retrospectively studied. The clinical manifestations, laboratory findings, and imaging results of patients with AAP were analyzed. AAP patients were further classified into mild/moderate and severe groups based on criteria used in previous studies. Clinical outcomes were compared between groups. Results: A total of 38 patients were enrolled in this study. The underlying disease included ALL (n=35) and lymphoma (n=3). The majority of patients developed AAP during the first phase, called remission induction (n=26, 68.4%), after a median of 2 peg-asp doses (range: 1-11). The DVLP regimen (n=23) is the most common peg-asp regimen used in AAP patients. Abdominal pain occurred after a median of 14.5 days (range: 1-50) from the last peg-asp administration, accompanied by abdominal distension (n=14), nausea (n=17), vomiting (n=21), and fever (n=19). Serum amylase elevation was reported in all AAP patients, of whom 65.8% (n=25) exhibited an elevation in the level of this enzyme three times the upper normal level, fulfilling the Atlanta criteria. The level of serum lipase (median days of elevation=23 days, range: 4-75) was significantly elevated compared with that of serum amylase (median days of elevation=9 days, range: 2-71) and persisted at a markedly high level after the level of serum amylase returned to normal. Common local complications included abdominal ascites (n=10) and peripancreatic fluid collection (n=8).

Demographics and risk factors for pediatric recurrent acute pancreatitis

“…Two recent retrospective series provide additional insights into recurrent AAP [50 ▪ ,51]. Asparaginase re-exposure is associated with high risk of recurrent AAP.…”

Adverse Reactions to Drugs of Special Interest in a Pediatric Oncohematology Service

“…Hypersensitivity/allergic reactions accounted for 9.5% of the episodes, while the rest of ADRs (90.5%) were considered dose-related or due to mechanisms other than hypersensitivity. For cytopenias and infections, the mechanism is well known; however, for other common complications such as hypertriglyceridemia or pancreatitis with pegaspargase, the mechanism is not fully established (genetic predisposition has been suggested) but hypersensitivity is highly unlikely ( Zhang et al, 2020 ). The incidence of ADR was 3.1/100 days at risk (95% CI 2.7–3.5), and for episodes of ADR incidence was 1.7/100 days at risk (95% CI 1.4–2).…”

Investigation of Single and Multiple Mutations Prediction Using Binary Classification Approach

“…From the reviewed articles, it is evident that a knowledge graph model is fruitful in deriving probable Side Effects for different drugs. Using a neighboring characteristic model, the proposed approach annotates four potential characteristics and their relationships [37][38][39][40]. The complex characteristics and relationships are further embedded into a knowledge graph based on drugs, results, target proteins and side effects.…”

“…A standard method used for natural Language Processing is known as Word2Vec where different bags of words are brought into a common context to eliminate the dependency on sparseness problems. Details of the words found in different sentences are grouped based on context and word vectors are derived from the bags of words [39]. Skip-gram architectures and a continuous bag of words are the common algorithms that are used for deriving the context in a group of words.…”