P0155 PP ACUTE PANCREATITIS IN CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA TREATED WITH L-ASPARGINASE.

Abstract

Introduction: L-asparginase (L-ASP)is an aminohydrolase enzyme derived from Escherichia coli, it is used in the treatment of Acute Lymphoblastic Leukemia (ALL), inducing remission in 83 to 95% of the children treated. One of the major toxicity effects of L-ASP is Acute Pancreatitis between 2.5 to 16%. Aim: To determine the frecuency and outcome of Acute pancreatitis in children with ALL treated with L-ASP in a Third Level Pediatric Hospital. Methods: The charts of all children with ALL admitted for treatment with L-ASP between July 1998 to July 2003 were reviewed. Those who developed acute pancreatitis were analysed retrospectively. Pancreatic toxicity was defined by the presence of clinical data (nausea, vomiting and abdominal pain), elevated serum amylase and/or lipase and pancreatic changes on the abdominal ultrasound and/or CT scan. Age, gender, clinical, biochemical, abdominal ultrasound, CT scan findings, complications, management, outcome and mortality data were collected. Results: During 5 years 194 of new ALL cases received chemotherapy (L-ASP, Vincristine and Prednisone). Pancreatic toxicity was found in 10/194, 4 male, 6 female, age 8.4 years (3.5 to 15.8). Clinical data was seen between day 1 to 8 after the last L-ASP dose, and up to the end of treatment (9 doses) in 8 cases. All 10 children had vomiting, nausea and abdominal pain. Higher enzymes levels were detected 24 to 48 h after symptoms. Serum lipase was 420 UI (325 to 4147 UI) and amylase 839 UI (45 to 1984 UI). Acute complications were hipocalcemia 9,hiperglycemia 5, metabolic acidosis 2, ALT elevation 2, and azotemia 1. Abdominal ultrasound and/or CT scan detected edema in 10/10 and necrosis in 7/10. All cases received nasogastric decompression and TPN. Pseudocyst formation developed in 3/10 cases, endoscopic cystogastrostomy was done successfully in 2/3 and 1 required surgery, somatostatin was used after drainage in the 3 cases. There was no mortality and chronic complications were Diabetes Mellitus in 2 and pancreatic inssufficiency in 2. Conclusion: The frecuency of acute pancreatitis related to L-ASP in our Hospital was 19.6%. The majority of the cases reported described cases usually self-limiting, although our cases responded favorably and there were no fatal consecuences, 40% developed chronic complications. Use of L-ASP should be monitored to detect early pancreatic toxicity.Early management may decrease the mobidity.