Retrospective analysis of severe hypertriglyceridemia following the use of PEG-asparaginase in children with acute lymphoblastic leukaemia /lymphoma

Background Hypertriglyceridemia (HTG) is an adverse effect of PEG-asparaginase therapy in treatment for acute lymphoblastic leukaemia (ALL). Severe HTG remains largely under diagnosed due to its often asymptomatic presentation. Data from Indian children are limited. Methods We conducted a retrospective analysis of children less than 18 years who developed severe HTG while on treatment with the BFM IC 2009 protocol for ALL/lymphoma during the period between April 2024 and March 2026. The severity of HTG was graded according to the US National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 6.0 based on serum triglyceride (TG) levels. Demographic characteristics, clinical presentation, biochemical parameters, management strategies, complications and outcomes were analysed. Results Six children developed severe HTG and the mean age was 11 years. The mean triglyceride level was 4475mg/dl. Four children were managed conservatively - hydration, low fat diet, HMG-coA reductase inhibitor and fenofibrate; and two required aggressive management. Five children recovered, but one child developed severe haemorrhagic pancreatitis and died. Conclusion Severe HTG is an important complication of PEG-asparaginase. Although most children responded to conservative management, severe HTG can result in life threatening complications. Larger prospective studies are needed to define optimal screening and management strategies.