Nutritional status as a risk factor for adverse events associated with L-Asparaginase in children with acute lymphoblastic leukemia

Abstract

Background:

Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer, and asparaginase (ASNase) is a key component of its treatment. However, ASNase is frequently associated with adverse events (AEs), such as pancreatitis and hypersensitivity reactions particularly with the Escherichia coli derived formulation (L-Asp) which may be influenced by nutritional status.

Objective:

To evaluate the association between protein-energy malnutrition (PEM) and the incidence of L-Asp induced AEs in children with ALL.

Methods:

A prospective observational cohort with a nested case-control comparative analysis was conducted in 91 pediatric patients treated with L-Asp. Anthropometric measurements, anti-L-Asp antibody detection, and AEs occurrence were assessed.

Results:

Eighteen patients (19.8%) developed AEs: six pancreatitis and 12 hypersensitivity reactions. Of these, 14 (77.7%) had PEM. PEM was significantly associated with AEs (OR = 12.22; p = 0.02). Pancreatitis occurred mostly during induction and affected 83.3% of PEM patients. Hypersensitivity reactions were more frequent during reinduction and were associated with anti-L-Asp antibodies in all cases, 75% of which had PEM.

Conclusions:

PEM was significantly linked to increased risk of L-Asp related toxicity, suggesting nutritional status as a modifiable factor. Early identification and correction of PEM may improve the safety profile of L-Asp in pediatric ALL therapy.