Octreotide Considered Effective against Acute Pancreatitis bacause of L-Asparaginase in a Case of Acute Lymphocytic Leukemia

Abstract

We encountered a case in which octreotide was considered effective against pancreatitis caused by L-asparaginase (L-asp) in a 16-year-old boy. Upper abdominal pain and vomiting occurred one day after he was administered L-asp (6, 000 IU/m² : 9, 000 IU) i.m. during maintenance treatment for acute lymphocytic leukemia. The serum amylase level at the time was 112 IU/l, but a CT examination of the abdomen revealed pancreatic swelling, and acute pancreatitis was diagnosed. Treatment with FOY, ulinastatin, and antibiotics was initiated. The next day, since the serum amylase had risen to 1, 027 IU/l and the abdominal pain had become aggravated, octreotide treatment was commenced. From the third day of disease, the serum amylase level began to fall, and by the sixth day it was almost normal, at 136 IU/l. During these events, the formation of a pancreatic pseudocyst was not observed. The administration of octreotide, which acts to inhibit pancreatic exocrine secretion, has been reported to significantly improve the rate of complications and the mortality in cases of pancreatitis. It is therefore a treatment that should be considered for acute pancreatitis caused by L-asp.