Severe hypertriglyceridaemia during therapy for childhood acute lymphoblastic leukaemia.
Severe hypertriglyceridaemia during therapy for childhood acute lymphoblastic leukaemia.
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DOI：
10.1016/j.ejca.2014.06.023
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发表时间：
2014-10
影响因子：
8.4
通讯作者：
Metzger, Monika L.
中科院分区：
文献类型：
--
作者：
Bhojwani, Deepa;Darbandi, Rashid;Pei, Deqing;Ramsey, Laura B.;Chemaitilly, Wassim;Sandlund, John T.;Cheng, Cheng;Pui, Ching-Hon;Relling, Mary V.;Jeha, Sima;Metzger, Monika L.
天冬酰胺酶和类固醇可引起急性淋巴细胞白血病（ALL）患儿高甘油三酯血症。在ALL治疗期间，没有筛查或管理严重高甘油三酯血症（> 1000mg /dL）患者的指南。在4个时间点前瞻性地获得了257名连续参加一线ALL研究的儿童的空腹脂质谱。采用精确卡方检验评估危险因素。回顾性提取高甘油三酯血症的不良事件和处理细节。257例患者中有18例（7%）发生了严重的高甘油三酯血症。年龄较大和在标准组/高危组使用高剂量的天冬酰胺酶和类固醇治疗是显著的危险因素。在调整年龄和治疗组后，严重的高甘油三酯血症与胰腺炎无关，也与年龄调整后的骨坏死无关。然而，严重高甘油三酯血症患者的血栓形成风险是无严重高甘油三酯血症患者的2.5 - 3倍，尽管差异无统计学意义。在18例患者的30次严重高甘油三酯血症发作中，7例采用保守治疗，其余采用药物治疗。18名患者中有17名继续接受天冬酰胺酶和类固醇治疗。所有12例患者的甘油三酯水平在完成ALL治疗后恢复正常。天冬酰胺酶和类固醇引起的一过性高甘油三酯血症可以通过饮食调整和密切监测来充分控制，而无需改变化疗。严重高甘油三酯血症患者的不良事件风险没有增加，可能有血栓形成的例外。药物治疗在减轻症状和潜在并发症方面的益处有待进一步研究。
Asparaginase and steroids can cause hypertriglyceridemia in children with acute lymphoblastic leukemia (ALL). There are no guidelines for screening or management of patients with severe hypertriglyceridemia (>1000 mg/dL) during ALL therapy. Fasting lipid profiles were obtained prospectively at 4 time-points for 257 children consecutively enrolled on a frontline ALL study. Risk factors were evaluated by the exact chi-square test. Details of adverse events and management of hypertriglyceridemia were extracted retrospectively. Eighteen of 257 (7%) patients developed severe hypertriglyceridemia. Older age and treatment with higher doses of asparaginase and steroids on the standard/high-risk arm were significant risk factors. Severe hypertriglyceridemia was not associated with pancreatitis after adjustment for age and treatment arm or with osteonecrosis after adjustment for age. However, patients with severe hypertriglyceridemia had a 2.5 to 3 times higher risk of thrombosis compared to patients without, albeit the difference was not statistical significant. Of the 30 episodes of severe hypertriglyceridemia in 18 patients, 7 were managed conservatively while the others with pharmacotherapy. Seventeen of 18 patients continued to receive asparaginase and steroids. Triglyceride levels normalized after completion of ALL therapy in all 12 patients with available measurements. Asparaginase- and steroid-induced transient hypertriglyceridemia can be adequately managed with dietary modifications and close monitoring without altering chemotherapy. Patients with severe hypertriglyceridemia were not at increased risk of adverse events, with a possible exception of thrombosis. The benefit of pharmacotherapy in decreasing symptoms and potential complications requires further investigation.
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影响因子：
20.3
作者：
Oudin, Claire;Simeoni, Marie-Claude;Michel, Gerard
通讯作者：
Michel, Gerard
影响因子：
20.3
作者：
Kawedia, Jitesh D.;Kaste, Sue C.;Relling, Mary V.
通讯作者：
Relling, Mary V.
影响因子：
5.3
作者：
Rosenson, RS;Shott, S;Tangney, CC
通讯作者：
Tangney, CC
DOI：
10.1056/nejmoa0900386
发表时间：
2009-06-25
期刊：
The New England journal of medicine
影响因子：
--
作者：
Pui CH;Campana D;Pei D;Bowman WP;Sandlund JT;Kaste SC;Ribeiro RC;Rubnitz JE;Raimondi SC;Onciu M;Coustan-Smith E;Kun LE;Jeha S;Cheng C;Howard SC;Simmons V;Bayles A;Metzger ML;Boyett JM;Leung W;Handgretinger R;Downing JR;Evans WE;Relling MV
通讯作者：
Relling MV
影响因子：
5.5
作者：
Kabata, T;Kubo, T;Tomita, K
通讯作者：
Tomita, K