PF817 INTENSIVE PLAN OF THERAPEUTIC PLASMA EXCHANGE IN PATIENT WITH EXTREME HYPERTRLIGLYCERIDEMIA DUE TO L‐ASPARAGINASE IN THE CONTEXT OF SMILE PROTOCOL IN T/NK NASAL LYMPHOMA TREATMENT

Abstract

Background:A 42 year‐old male patient was diagnosed in July 2018 of extranodal T / NK lymphoma, nasal type, EBV + CD56 +, IIA Stage, IPI 1, with right thigh mass and inguinal adenopathies. He received chemotherapy according to the SMILE protocol, that included dexamethasone, methotrexate, ifosfamide, etoposide and L‐asparaginase, starting in August 2018 together with local radiotherapy in the mass concomitantly. As a personal medical history, he was under treatment with Rosuvastatin for familial hypercholesterolemia and hypertriglyceridemia, that was well controlled.Aims:To prove that carry out an aggressive prophylactic apheresis schedule, allows to reduce the complications derived from hypertriglyceridemia due to L‐ASA and to administer full chemotherapy that entails greater possibilities of cure.Methods:One T/NK Nasal Lymphoma patient with familial dyslipidemia suffered multiple events of extreme hypertriglyceridemia (TAGs>1200) that required a total of twenty‐two therapeutic plasma exchanges (TPE) to be able to administer Lasparaginase.Results:During the first cycle after the 5th dose of L‐asparaginase the patient presents extreme hypertriglyceridemia (9016 mg /dl) and two TPE was done with very good response, TAGs of 511 mg/dl and 251 mg/dl after the 1st and 2nd apheresis, respectively. Due to it was an unexpected event, conservative management was performed and he did not receive the last two doses of L‐Asa. Due to the importance of L‐ASA,we optimized oral treatment and carried out an intense apheresis program since second cycle and every L‐ASA doses was received. The patient achieve completed metabolic response after the 3rdcycle. On the day +20 of the 6th cycle, coinciding with the last dose of L‐asa, it was decided not to make prophylactic plasma exchanges for TAG values of less than 1500 mg/dl (1361 mg /dl). 48 hours later he went to the emergency department and was diagnosed of acute acalculous pancreatitis in the context of hypertriglyceridemia secondary to L‐ASA (TAGs 7168 mg / dl). Two plasma exchanges were performed on days +23 and +24, with good response (decrease from 7168 to 580 TAGs).Summary/Conclusion:In patients with a family history of dyslipidemia maintain prophylactic apheresis until the administration of L‐asparaginase has been fully completed, maintaining <1000 TAG level is essential to improve the results.Moreover, an exhaustive follow‐up should be carried out in these patients, confirming 24 hours after the end of treatment that the TAGs value continues to be <1000 mg/dl and the patient is not at risk of developing pancreatitis.