Abstract Ref Number = APCP925
ACUTE PANCREATITIS DURING INDUCTION PHASE OF CHEMOTHERAPY IN PEDIATRIC ACUTE LYMPHOBLASTIC LEUKEMIA
Helen Talolena,Andi cahyadi,Maria Christina shanty Larasati,Mia Ratwita,I Dewa Gede Ugrasena,Bambang Permono
Department of child Health Faculty of Medicine Universitas Airlangga Dr Soetomo Hospital Surabaya Indonesia
Background : Acute pancreatitis (AP) is a complication in children with acute lymphoblastic leukemia (ALL) receiving L-asparaginase (L-asp) therapy. L-asp was used as main chemotherapy for induction phase in children with acute lymphoblatic leukemia (ALL). L-asp was correlated with the risk of dysfunctions of the liver and pancreas. AP induced by L-asparaginase has been rare reported, but this side effect has predominantly among pediatric ALL. We report the acute pancreatitis in pediatric ALL in Dr. Soetomo Hospital.
Material : We reported AP induced by L-asp among pediatric ALL at Dr. Soetomo Hospital from 2013 to 2018 who got Indonesian ALL protocol 2013. They got 9 doses of 7500 unit/m2 L-asp for high risk (HR) group and 6 doseS of 7500 unit/m2 L-asp for standard risk (SR) group during induction phase of chemotherapy. AP was based on clinical symptom (acute abdomen, jaundice, hyperthermia) and increasing of amylase and lipase serum. Some imaging were performed for some patient. Demographic, clinical symptom, amylase and lipase level were obtained from medical record.
Results : There were 10 patients from 181 children who finished induction phase of chemotherapy. The median age was 5 (2-14) years, 8/10 were male. Four patients received HR protocol and 6/10 received SR protocol. The main symptoms were fever (10/10), abdominal pain (8/10), jaundice (4/10), and vomiting (2/10). The median of amylase enzyme was 1184 (1021 to 1452) U/L and median of lipase enzyme was 365 (241 to 541) U/L. Acute pancreatitis occurred on median 5.5 (SD 1.79 ) after L-asp injection. All children postponed chemotherapy until median 4 (SD 2.71) weeks, after the symptomps resolved. Four of 10 patients died due to acute pancreatitis episode.
Conclusions : AP induced by L-asp in pediatric ALL is rare case, can resolve but some patiens have high mortality.
Keywords: pediatric acute lymphoblastic leukemia L-asparaginase acute pancreatitis