Key result
Higher TG/HDL-C ratio seven days post-PEG-asparaginase predicts ~81% greater odds of severe hypertriglyceridemia per unit.
Why the study?
Steroids and L-asparaginase frequently cause treatment-related hypertriglyceridemia in paediatric patients with lymphoid cancers, prompting analysis of risk factors determining severe hypertriglyceridemia development.
Does the TG/HDL-C ratio predict the development of treatment-related severe hypertriglyceridemia in pediatric patients with lymphoid malignancies?
Case-Control (n=37)
No
Does the TG/HDL-C ratio predict the development of treatment-related severe hypertriglyceridemia in pediatric patients with lymphoid malignancies?
Odds Ratio: 1.808
p-value: p=<0.005
The TG/HDL-C ratio measured seven days after the first PEG-asparaginase dose is a strong, simple predictor of severe hypertriglyceridemia in children undergoing treatment for lymphoid malignancies.
May identify at-risk children during PEG-asparaginase therapy; hypothesis-generating and requires prospective validation before practice change.
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.
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Małecka et al. (2026) conducted a case-control in Lymphoid tissue cancers (acute lymphoblastic leukemia and lymphoblastic lymphoma) (n=37). TG/HDL-C ratio vs. Lower TG/HDL-C ratio was evaluated on Development of severe hypertriglyceridemia (TG > 500 mg/dl) (OR 1.808, p=<0.005). A higher TG/HDL-C ratio assessed seven days after the first PEG-asparaginase dose strongly predicted severe hypertriglyceridemia (AUC 0.853), with a 1.808-fold increased odds per unit increase.
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