Hypertriglyceridemia During Anticancer Therapy in Pediatric Patients with Acute Lymphoblastic Leukemia – A Nationwide Experience

Joanna Zawitkowska,1,2 Eryk Latoch,3,4 Katarzyna Karska,1 Katarzyna Drabko,1 Monika Lejman,5 Klaudia Ewelina Paczóska,6 Tomasz Ociepa,6 Anna Malecka,7 Dorota Sęga-Pondel,8 Krzysztof Kalwak,8 Katarzyna Konończuk,3 Julia Kołodrubiec,9 Joanna Trelińska,9 Ewa Demidowicz,10 Marta Andrzejewska,2,11 Katarzyna Derwich,2 Zuzanna Zakrzewska,12 Szymon Skoczeń,12 Agnieszka Mizia-Malarz,13 Grażyna Karolczyk,14 Wioletta Bal,15 Radosław Chaber,15 Patrycja Tyszka,16 Wanda Badowska,16 Mariola Janiszewska,17 Jerzy Kowalczyk,1 Wojciech Młynarski,9 Tomasz Szczepański,18 Jan Styczyński,10 Ninela Irga-Jaworska,7 Katarzyna Muszyńska-Rosłan3 1Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland; 2Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences in Poznań, Institute of Pediatrics, Poznań, Poland; 3Department of Pediatrics, Oncology and Hematology, Medical University of Białystok, Białystok, Poland; 4Department of Neurology and Pediatrics, Medical University of Białystok, Białystok, Poland; 5Independent Laboratory of Genetic Diagnostics, Medical University of Lublin, Lublin, Poland; 6Department of Pediatrics and Hemato-Oncology, Pomeranian Medical University in Szczecin, Szczecin, Poland; 7Department of Pediatrics, Hematology and Oncology, Medical University of Gdańsk, Gdańsk, Poland; 8Department of Pediatric Bone Marrow Transplantation, Oncology and Haematology, Wrocław Medical University, Wrocław, Poland; 9Department of Pediatrics, Oncology & Hematology, Medical University of Lodz, Lodz, Poland; 10Department of Pediatric, Hematology, Oncology, Immunology and Transplantology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland; 11Doctoral School, Poznan University of Medical Sciences, Poznań, Poland; 12Department of Pediatric Oncology and Hematology, University Children’s Hospital, Institute of Pediatrics, Jagiellonian University Medical College, Kraków, Poland; 13Department of Oncology, Hematology and Chemotherapy, Medical University of Silesia, Upper Silesian Children’s Health Centre, Katowice, Poland; 14Department of Pediatric Oncology and Hematology, Children’s Hospital, Kielce, Poland; 15Department of Pediatrics, Clinic of Pediatric Oncology and Hematology, Faculty of Medicine, University of Rzeszow, State Hospital, Rzeszow, Poland; 16Clinical Department of Pediatrics, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland; 17Department of Medical Informatics and Statistics with E-Health Lab, Medical University of Lublin, Lublin, Poland; 18Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia, Katowice, PolandCorrespondence: Joanna Zawitkowska, Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland, Tel +48 81 71 85 307, Fax +48 81747 72 20, Email [email protected]: In this study, we aimed to assess the demographics and incidence of hypertriglyceridemia (HTG) during acute lymphoblastic leukemia (ALL) treatment, complications related to HTG, and the treatment strategies applied in pediatric patients treated in pediatric hemato-oncology centers in Poland.Patients and Methods: A total of 72 out of 641 children, aged < 18 years with ALL were diagnosed with HTG as a treatment-related complication. Statistical analyses were conducted with a significance level of α = 0.05.Results: The emergence of HTG is a significant complication, with median peak triglyceride levels during treatment reaching 1385.00 mg/dL. Only 5.56% (n = 4) experienced complications. No patients developed pancreatitis. Treatment interruptions were minimal (a median 5.67 days). No children died due to HTG. Management strategies for HTG management included plasmapheresis in 8.3% (n = 6/72). Other therapies – insulin (23.6%, n = 17), heparin (34.7%, n = 25), fibrates (41.7%, n = 30), and omega-3 fatty acids (58.3%, n = 45). A correlation was observed between low antithrombin levels and high TG levels.Conclusion: This is the first nationwide, multicenter analysis conducted across pediatric hemato-oncology centers in Poland evaluating HTG during ALL therapy. HTG occurred in 11.1% of children in the analyzed cohort, and 72% of these cases were grade 3 or 4. With the management strategies applied, severe complications were uncommon and chemotherapy interruptions were generally short. Our findings support the effective triglyceride monitoring; however, triglyceride measurements are currently not standardized and are not performed at predefined time points during treatment. The observed association between low antithrombin levels and high triglyceride concentrations may help identify patients who require closer surveillance. Further prospective studies are needed to define risk factors, optimize prevention and treatment strategies and explore long-term outcomes.Keywords: lipid disorders, childhood leukemia, supportive care, toxicities