Triglyceride/HDL-cholesterol ratio as a predictor for treatment-related severe hypertriglyceridemia in children with lymphoid malignancies

Two crucial elements of treatment regimens for lymphoid tissue cancers are steroids and L-asparaginase, and both can lead to metabolic complications. Treatment-related hypertriglyceridemia (HTG) occurs in 7-29% of paediatric patients. The purpose of this study was to analyze factors determining the risk for development of severe HTG in children suffering from lymphoid tissue cancers and treated with steroids and PEG-asparaginase. Case control study included 37 paediatric patients with lymphoid tissue cancers, who were divided into two groups depending on severe HTG development until the initiation of the maintenance treatment. Baseline anthropometric and laboratory parameters showed limited predictive value for severe HTG. Triglycerides (TG), HDL-cholesterol (HDL-C) and TG/HDL-C ratio assessed seven days after the first PEG-asparaginase dose differed significantly between non-HTG and HTG patients (p < 0.05). The ratio demonstrated the strongest discriminatory ability (AUC = 0.853; p < 0.001). Logistic regression showed a 1.808-fold rise in the odds of high risk of severe HTG-development for each unit increase in TG/HDL-C. The TG/HDL-C ratio assessed seven days after first PEG-asparaginase administration may serve as a simple and cost-effective tool for identifying paediatric patients with lymphoid tissue cancers at high risk of severe HTG development, enabling timely preventive and therapeutic interventions. Further large-scale prospective studies are needed to confirm its clinical utility.