Incidence and risk factors for hypoglycemia during maintenance chemotherapy in pediatric acute lymphoblastic leukemia.
Incidence and risk factors for hypoglycemia during maintenance chemotherapy in pediatric acute lymphoblastic leukemia.
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DOI：
10.1002/pbc.29467
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发表时间：
2022-06
影响因子：
3.2
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中科院分区：
文献类型：
--
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急性淋巴细胞性白血病(ALL)患儿在维持治疗期间发生空腹低血糖是公认的。描述这一发现的现有出版物仅限于小型研究和案例报告。我们的目标是确定维持化疗期间低血糖的发生率，并调查年龄和其他潜在危险因素与儿童急性淋巴细胞白血病患者预后的关系。这项回顾性队列研究包括2011年1月至2014年12月期间在一家大型儿童医院接受抗代谢维持化疗的1至21岁的患者。主要终点是在维持治疗期间首次记录低血糖发作的时间，定义为单次测量血糖60 mg/dL。用COX回归来评估与年龄的关系，并确定其他潜在的危险因素。我们确定了126名符合条件的患者，其中63%被记录为白人，非西班牙裔，28%为非白人，非西班牙裔，9%为西班牙裔。28名儿童(22%)在维持治疗期间有低血糖的记录。低血糖与低血糖相关(调整后HR年龄=0.88，95%CI[0.78~0.99]；调整HR既往肝毒性=3.50，95%CI[1.47~8.36])。在我们的队列中，近四分之一的儿童在维持化疗期间有低血糖记录。维持开始时年龄较小和维持开始前化疗期间的肝毒性是危险因素。这些发现强调了咨询低血糖的风险和监测的重要性，特别是在幼儿中。
Fasting hypoglycemia is a recognized occurrence among pediatric patients with acute lymphoblastic leukemia (ALL) during maintenance therapy. Existing publications describing this finding are limited to small studies and case reports. Our objective was to determine the incidence of hypoglycemia during maintenance chemotherapy and to investigate the association of age, as well as other potential risk factors, with this outcome in pediatric patients with ALL. This retrospective cohort study included individuals 1 to 21 years of age with ALL treated with antimetabolite-containing maintenance chemotherapy at a large children’s hospital between January 2011 and December 2014. The primary endpoint was time to first documented episode of hypoglycemia during maintenance therapy, defined as single measurement of plasma glucose <60 mg/dL. Cox regression was used to evaluate the association with age and identify other potential risk factors. We identified 126 eligible patients, of whom 63% were documented as White, non-Hispanic, 28% as non-White, non-Hispanic, and 9% as Hispanic. Twenty-eight children (22%) had documented hypoglycemia during maintenance therapy. Younger age at the start of maintenance and hepatotoxicity documented during chemotherapy prior to maintenance initiation were associated with hypoglycemia (adjusted HR age=0.88, 95% CI [0.78–0.99]; adjusted HR prior hepatotoxicity=3.50, 95% CI [1.47–8.36]). Nearly one-quarter of children in our cohort had hypoglycemia documented during maintenance chemotherapy. Younger age at maintenance initiation and hepatotoxicity during chemotherapy prior to maintenance initiation emerged as risk factors. These findings highlight the importance of counseling about the risk of, and monitoring for, hypoglycemia, particularly in young children.
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影响因子：
3.2
作者：
Bay, Ali;Oner, Ahmet Faik;Sanli, Fatih
通讯作者：
Sanli, Fatih
影响因子：
3.8
作者：
Halonen, P;Salo, MK;Mäkipernaa, A
通讯作者：
Mäkipernaa, A
影响因子：
5.8
作者：
HAYMOND, MW;KARL, IE;PAGLIARA, AS
通讯作者：
PAGLIARA, AS
影响因子：
1.4
作者：
White, Kathryn;Truong, Lisa;Thornton, Paul S.
通讯作者：
Thornton, Paul S.
影响因子：
5.2
作者：
Bodamer, O. A.;Hussein, K.;Leonard, J. V.
通讯作者：
Leonard, J. V.