2024 Volume 61 Issue 3 Pages 271-277
Among the therapeutic agents used in pediatric patients with hematologic malignancies, L-asparaginase and glucocorticoid are known to cause hypertriglyceridemia. Thrombosis and osteonecrosis are complications associated with hypertriglyceridemia during acute lymphoblastic leukemia (ALL) treatment. However, the risk factors for hypertriglyceridemia and their association with each complication remain unclear. This retrospective analysis investigated the risk factors for hypertriglyceridemia during ALL and lymphoma treatment at our hospital and its effects on patients during and after treatment.
Of the 138 eligible patients, 38 (27.5%) developed grade 4 hypertriglyceridemia during treatment according to the Common Terminology Criteria for Adverse Events version 5. Old age at diagnosis was a risk factor for hypertriglyceridemia. However, hypertriglyceridemia and the type of glucocorticoid or L-asparaginase dose were not associated. A median follow-up of 6 years and 2 months revealed that 14 patients had osteonecrosis, 10 had drug-induced diabetes, three had pancreatitis, and one had thrombosis. All patients experienced grade ≥3 hypertriglyceridemia during treatment. The median times to onset of complications after diagnosis of osteonecrosis, drug-induced diabetes, pancreatitis, and thrombosis were 28, 11, 1, and 6 months, respectively. Multivariate analysis revealed that peak triglyceride levels during hypertriglyceridemia was not correlated with pancreatitis and thrombosis but was a significant independent risk factor for osteonecrosis and drug-induced diabetes.
The results indicated that high triglyceride levels during treatment may contribute to the development of osteonecrosis and drug-induced diabetes. Therefore, close monitoring of patients with high triglyceride levels may aid in the early detection and treatment of these complications.
