Top

Published in:

Open Access 01-12-2012 | Case report

Hypoglycemia associated with L-asparaginase in acute lymphoblastic leukemia treatment: a case report

Authors: Ryuma Tanaka, Tomoo Osumi, Masashi Miharu, Tomohiro Ishii, Tomonobu Hasegawa, Takao Takahashi, Hiroyuki Shimada

Published in: Experimental Hematology & Oncology | Issue 1/2012

Abstract

A patient with acute lymphoblastic leukemia repeatedly developed hypoglycemia during chemotherapy. Comparison of serum glucose trends between chemotherapy with and without L-asparaginase (L-Asp) demonstrated a strong association between L-Asp and hypoglycemia. Critical blood sampling during hypoglycemia indicated hyperinsulinism, suggesting that L-Asp induced hypoglycemia in the patient through inappropriate insulin secretion. Identification of hypoglycemia as an adverse effect will enable clinicians to understand and develop appropriate strategies for L-Asp use in chemotherapy regimens.

Available only for authorised users

Möricke A, Zimmermann M, Reiter A, Henze G, Schrauder A, Gadner H, Ludwig WD, Ritter J, Harbott J, Mann G, Klingebiel T, Zintl F, Niemeyer C, Kremens B, Niggli F, Niethammer D, Welte K, Stanulla M, Odenwald E, Riehm H, Schrappe M: Long-term results of five consecutive trials in childhood acute lymphoblastic leukemia performed by the ALL-BFM study group from 1981 to 2000. Leukemia 2010, 24: 265–284. 10.1038/leu.2009.257PubMedCrossRef

Tsuchida M, Ohara A, Manabe A, Kumagai M, Shimada H, Kikuchi A, Mori T, Saito M, Akiyama M, Fukushima T, Koike K, Shiobara M, Ogawa C, Kanazawa T, Noguchi Y, Oota S, Okimoto Y, Yabe H, Kajiwara M, Tomizawa D, Ko K, Sugita K, Kaneko T, Maeda M, Inukai T, Goto H, Takahashi H, Isoyama K, Hayashi Y, Hosoya R, Hanada R, Tokyo Children’s Cancer Study Group: Long-term results of Tokyo Children’s Cancer Study Group trials for childhood acute lymphoblastic leukemia, 1984–1999. Leukemia 2010, 24: 383–396. 10.1038/leu.2009.260PubMedCrossRef

Gaynon PS, Angiolillo AL, Carroll WL, Nachman JB, Trigg ME, Sather HN, Hunger SP, Devidas M, Children’s Oncology Group: Long-term results of the children’s cancer group studies for childhood acute lymphoblastic leukemia 1983–2002: a Children’s Oncology Group Report. Leukemia 2010, 24: 285–297. 10.1038/leu.2009.262PubMedCentralPubMedCrossRef

Pession A, Valsecchi MG, Masera G, Kamps WA, Magyarosy E, Rizzari C, van Wering ER, Lo Nigro L, van der Does A, Locatelli F, Basso G, Aricò M: Long-term results of a randomized trial on extended use of high dose L-asparaginase for standard risk childhood acute lymphoblastic leukemia. J Clin Oncol 2005, 23: 7161–7167. 10.1200/JCO.2005.11.411PubMedCrossRef

Raetz EA, Salzer WL: Tolerability and efficacy of L-asparaginase therapy in pediatric patients with acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2010, 32: 554–563. 10.1097/MPH.0b013e3181e6f003PubMedCrossRef

Pui CH, Burghen GA, Bowman WP, Aur RJ: Risk factors for hyperglycemia in children with leukemia receiving L-asparaginase and prednisone. J Pediatr 1981, 99: 46–50. 10.1016/S0022-3476(81)80955-9PubMedCrossRef

Carpentieri U, Balch MT: Hyperglycemia associated with the therapeutic use of L-asparaginase: possible role of insulin receptors. J Pediatr 1978, 93: 775–778. 10.1016/S0022-3476(78)81075-0PubMedCrossRef

Roberson JR, Raju S, Shelso J, Pui CH, Howard SC: Diabetic ketoacidosis during therapy for pediatric acute lymphoblastic leukemia. Pediatr Blood Cancer 2008, 50: 1207–1212. 10.1002/pbc.21505PubMedCrossRef

Manabe A, Ohara A, Hasegawa D, Koh K, Saito T, Kiyokawa N, Kikuchi A, Takahashi H, Ikuta K, Hayashi Y, Hanada R, Tsuchida M: Tokyo Children’s Cancer Study Group: Significance of the complete clearance of peripheral blasts after 7 days of prednisolone treatment in children with acute lymphoblastic leukemia: the Tokyo Children’s Cancer Study Group Study L99–15. Haematologica 2008, 93: 1155–1160. 10.3324/haematol.12365PubMedCrossRef

10.

Conter V, Bartram CR, Valsecchi MG, Schrauder A, Panzer-Grümayer R, Möricke A, Aricò M, Zimmermann M, Mann G, De Rossi G, Stanulla M, Locatelli F, Basso G, Niggli F, Barisone E, Henze G, Ludwig WD, Haas OA, Cazzaniga G, Koehler R, Silvestri D, Bradtke J, Parasole R, Beier R, van Dongen JJ, Biondi A, Schrappe M: Molecular response to treatment redefines all prognostic factors in children and adolescents with B-cell precursor acute lymphoblastic leukemia: results in 3184 patients of the AIEOP-BFM ALL 2000 study. Blood 2010, 115: 3206–3214. 10.1182/blood-2009-10-248146PubMedCrossRef

11.

Schrey D, Borghorst S, Lanvers-Kaminsky C, Hempel G, Gerss J, Möricke A, Schrappe M, Boos J: Therapeutic drug monitoring of asparaginase in the ALL-BFM 2000 protocol between 2000 and 2007. Pediatr Blood Cancer 2010, 54: 952–958.PubMed

12.

Meikle AW, Tyler FH: Potency and duration of action of glucocorticoids. Effects of hydrocortisone, prednisone and dexamethasone on human pituitary-adrenal function. Am J Med 1977, 63: 200–207. 10.1016/0002-9343(77)90233-9PubMedCrossRef

13.

Watanabe S, Miyake K, Ogawa C, Matsumoto H, Yoshida K, Hirabayashi S, Hasegawa D, Inoue T, Kizu J, Machida R, Ohara A, Hosoya R, Manabe A: The ex vivo production of ammonia predicts L-asparaginase biological activity in children with acute lymphoblastic leukemia. Int J Hematol 2009, 90: 347–352. 10.1007/s12185-009-0419-xPubMedCrossRef

14.

Tsurusawa M, Chin M, Iwai A, Nomura K, Maeba H, Taga T, Higa T, Kuno T, Hori T, Muto A, Yamagata M: Japanese Children’s Cancer and Leukemia Study Group: L-Asparagine depletion levels and L-asparaginase activity in plasma of children with acute lymphoblastic leukemia under asparaginase treatment. Cancer Chemother Pharmacol 2004, 53: 204–208. 10.1007/s00280-003-0734-5PubMedCrossRef

15.

Ben Salem C, Fathallah N, Hmouda H, Bouraoui K: Drug-induced hypoglycemia: an update. Drug Saf 2011, 34: 21–45. 10.2165/11538290-000000000-00000PubMedCrossRef

16.

Lowas SR, Marks D, Malempati S: Prevalence of transient hyperglycemia during induction chemotherapy for pediatric acute lymphoblastic leukemia. Pediatr Blood Cancer 2009, 52: 814–818. 10.1002/pbc.21980PubMedCrossRef

17.

Hagop MK, Susan O, Terry LS, Cortes J, Giles FJ, Beran M, Pierce S, Huh Y, Andreeff M, Koller C, Ha CS, Keating MJ, Murphy S, Freireich EJ: Results of Treatment With Hyper-CVAD, a Dose-Intensive Regimen, in Adult Acute Lymphocytic Leukemia. J Clin Oncol 2000, 18: 547–561.

Title: Hypoglycemia associated with L-asparaginase in acute lymphoblastic leukemia treatment: a case report
Authors: Ryuma Tanaka
Tomoo Osumi
Masashi Miharu
Tomohiro Ishii
Tomonobu Hasegawa
Takao Takahashi
Hiroyuki Shimada
Publication date: 01-12-2012
Publisher: BioMed Central
Published in: Experimental Hematology & Oncology / Issue 1/2012
Electronic ISSN: 2162-3619
DOI: https://doi.org/10.1186/2162-3619-1-8

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2012

Isolated cardiac metastasis from plasmacytoid urothelial carcinoma of the bladder

Hyperphosphatemia during spontaneous tumor lysis syndrome culminate in severe hypophosphatemia at the time of blast crisis of Phneg CML to acute myelomoncytic leukemia

BIRC6 (APOLLON) is down-regulated in acute myeloid leukemia and its knockdown attenuates neutrophil differentiation

Immune modulation therapy in the management of bortezomib-induced peripheral neuropathy

Current management and prognostic features for gastrointestinal stromal tumor (GIST)

Numerical analysis of airflow alteration in central airways following tracheobronchial stent placement

Keynote webinar | Spotlight on antibody–drug conjugates in cancer