Hypertriglyceridemia associated with anticancer therapy based on asparaginase and steroids: a retrospective single center study of children with acute lymphoblastic leukemia and lymphoblastic lymphoma

Introduction: Hypertriglyceridemia (HTG) is one of the common complications of the regimens based on steroids and asparaginase used in the treatment of acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) in children. The aim of this cross-sectional retrospective study was the analysis of the prevalence, clinical course and management of hypertriglyceridemia following the administration of asparaginase and steroids according to the binding protocols. Material and methods: A cohort of 75 children with ALL or LBL was analyzed with reference to anthropometric and laboratory parameters, clinical symptoms, implemented treatment, and complications. Results: The prevalence of HTG in the analyzed cohort was 29.3%. Risk factors for HTG development were older age, cachexia and lower body mass index, but there was no correlation with high risk group. Patients with HTG presented with elevated lipase acivity and total cholesterol concentration and decreased antithrombin, albumin, sodium and high-density lipoprotein cholesterol. Reported symptoms were unspecific. Management of HTG included: omega 3 fatty acids, fibrates, insulin and plasmapheresis. Conclusions: Hypertriglyceridemia is a significant complication of ALL and LBL treatment, and can lead to acute and late complications and cause unwelcome interruptions to therapy that can lead to poorer outcomes of treatment. As the course of HTG is oligosymptomatic, but can have undesirable repercussions, every patient receiving asparaginase with steroids should be monitored for HTG. It is also noteworthy that HTG can occur three or more weeks after asparaginase administration.