Nutrition management of children with acute necrotizing pancreatitis following asparaginase: A case series

Asparaginase is a critical component of modern therapy for acute lymphoblastic leukemia (ALL). Its use has improved cure rates for both children and adults with this disease. However, asparaginase therapy can be complicated by significant toxicities, including acute pancreatitis (AP). Such pancreatitis can be severe and result in life-threatening or fatal complications. Here, we describe five cases of severe asparaginase-induced pancreatitis in children receiving therapy for ALL. Despite maximal supportive care, these patients experienced severe symptoms and were unable to tolerate enteral nutrition (EN) initially after presentation. This case series highlights clinical features associated with intolerance to EN in this population. Providers should be mindful of these features when considering EN trials in patients with severe asparaginase-associated AP. Some patients may require total parenteral nutrition to adequately support nutrition and recovery in severe asparaginase-associated AP.