Hypertriglyceridemia with Pancreatitis, a Complication of L-asparaginase Therapy in Acute Lymphoblastic Leukemia, Managed by Therapeutic Plasma Exchange

Abstract

A confirmed case of 41-year-old male with T-cell precursor acute lymphoblastic leukemia was inducted to BFM 2002 protocol, induction phase 1 (this protocol includes injection daunorubicin, vincristine, L-asparaginase with triple intrathecal injection of methotrexate, cytosine, hydrocortisone, and oral prednisolone). The patient complained of epigastric pain with hepatosplenomegaly and laboratory investigation revealed deranged lipid profile with hypertriglyceridemia (HTG) as a major feature and hyperbilirubinemia and raised transaminase. He was diagnosed with a case of HTG with acute pancreatitis, a complication, due to L-asparaginase. Initially, his condition was treated with medical management, but reduction in triglyceride (TG) level was not as expected. It was decided then to manage the case with concomitant therapeutic plasma exchange therapy. One exchange not only reduced the TG level drastically but also the bilirubin level and the patient recovered and was able to start the next phase of the protocol.