Risk factors of asparaginase-associated pancreatitis in children with acute lymphoblastic leukaemia

Background: Acute lymphoblastic leukaemia (ALL) is the top childhood cancer, with survival rates of 80–85%. Attention now focuses on treatment complications. Pancreatitis, linked to Asparaginase in ALL therapy, remains poorly understood despite its recognition. The main objective of the study was to identify the risk factors of pancreatitis in children with acute lymphoblastic leukemia receiving L-Asparaginase during induction chemotherapy. Methods: A prospective observational study was conducted at BSMMU's Paediatric Haematology and Oncology Department from March 2018 to February 2019. Newly diagnosed ALL cases in children aged 1 to 17.9 years were included, excluding those <1 or >18 years, with prior pancreatitis, or relapsed cases. Informed consent was obtained from parents/legal guardians. Diagnosis relied on clinical, CBC, bone marrow and immunophenotyping. Induction chemotherapy followed the UK ALL 2003 protocol for 35 days, with regular follow-ups monitoring abdominal symptoms and laboratory markers. USG of the abdomen was performed if pancreatitis symptoms or elevated serum amylase/lipase occurred post-L-asparaginase administration. Results: Among 80 patients, pancreatitis affected 3 (3.8%) after the 2nd, 3rd and 7th doses of L-asparaginase, independent of individual or cumulative dosing, induction phase or concomitant medications. Age, sex, initial WBC count, ALL lineage, treatment regimen and CNS status were not statistically linked to pancreatitis incidence. Clinical manifestations included abdominal pain, tenderness, nausea, vomiting and fever, alongside elevated serum amylase and lipase levels, supported by consistent ultrasonographic findings. Despite these symptoms, no pancreatitis-related mortalities were observed, however, overall mortality during induction therapy reached 20%, unrelated to pancreatic complications. Conclusions: In this study no significant risk factor could be identified for developing pancreatitis in ALL patients treated with asparaginase. Further studies with large sample size are required to predict who will develop pancreatic toxicity from asparaginase.