Severe L-asparaginase-induced Hypertriglyceridaemia Treated with Plasmapheresis

Abstract

L-asparaginase is used for the treatment of acute lymphoblastic leukaemia. Hypertriglyceridaemia is a side effect and associated with potentially fatal complications, including acute pancreatitis. Plasmapheresis may have a role in treatment when triglycerides are >2000 mg/dl. We report the case of a 39-year-old woman treated with L-asparaginase for acute lymphoblastic leukaemia, who developed severe hypertriglyceridaemia (6560 mg/dl) and acute pancreatitis. Intravenous insulin infusion was started, along with fenofibrate and atorvastatin administration, and platelet transfusion. Plasmapheresis was carried out leading to a frank decline in serum triglyceride levels (366 mg/dl), a decrease in pancreatic enzymes and clinical improvement. The diagnosis of pancreatitis secondary to L-asparaginase should lead to immediate drug withdrawal, and plasmapheresis should be considered when serum triglyceride values exceed 2000 mg/dl. In our case, there was a 95% triglyceride removal rate. This response illustrates the strong effectiveness of early treatment with plasmapheresis in severe and symptomatic hypertriglyceridaemia associated with L-asparaginase.

Acute Pancreatitis Caused by Pegylated (PEG)-Asparaginase Associated With Severe Hypertriglyceridemia

“…Asparaginase is used in B-ALL during the induction and intensification phases of treatment [ 2 ]. The primary target of asparaginase is malignant lymphoblasts, which work by causing the depletion of the external sources of asparagine through the hydrolysis of asparagine into aspartic acid [ 3 ]. As most malignant lymphoblasts have limited asparagine synthetase activity to synthesize asparagine, its lack leads to apoptosis of the lymphoblasts [ 4 ].…”

Severely Deranged Lipid Profile

“…The management options target the complications and treating the hypertriglyceridemia. [ 4 ] It includes low-fat diets, fibrate therapy, heparinization, insulin infusion; and/or plasmapheresis. [ 5 ]…”