Kearney Susan L, Dahlberg Suzanne E, Levy Donna E, Voss Stephan D, Sallan Stephen E, Silverman Lewis B
Division of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, University of Minnesota, Minneapolis, Minnesota, USA.
Pediatr Blood Cancer. 2009 Aug;53(2):162-7. doi: 10.1002/pbc.22076.
Asparaginase, an agent used in the treatment of acute lymphoblastic leukemia (ALL), is associated with the development of pancreatitis. The clinical course and long-term outcome of patients experiencing this complication has not been extensively detailed.
We reviewed the clinical course for all children with ALL diagnosed with pancreatitis at the Dana-Farber Cancer Institute/Children's Hospital Boston between 1987 and 2003. The outcome of these patients was compared with that of patients with ALL who did not experience pancreatitis.
Twenty-eight of 403 children (7%) were diagnosed with pancreatitis. Patients 10-18 years old at diagnosis had 2.4 times the risk of developing pancreatitis compared with younger patients. Pancreatitis typically occurred early in the course of therapy (median 4 weeks after first dose of asparaginase). Ninety-three percent of affected patients were hospitalized and 57% received parenteral nutrition. No patient developed chronic sequelae or died as a result of pancreatitis. Sixteen (57%) patients were re-treated with asparaginase, 10 of whom had another episode of pancreatitis. No significant differences in event-free survival were observed when comparing patients with and without a history of pancreatitis.
Asparaginase-associated pancreatitis was more common in older children, and caused significant acute morbidity. It tended to occur after the first few doses of asparaginase, suggesting a predisposition to this complication rather than a cumulative drug effect. Re-treatment with asparaginase after an episode of pancreatitis was associated with a high risk of recurrent pancreatitis.
天冬酰胺酶是一种用于治疗急性淋巴细胞白血病（ALL）的药物，与胰腺炎的发生有关。经历这种并发症的患者的临床病程和长期预后尚未得到广泛详细的描述。
我们回顾了1987年至2003年间在丹娜-法伯癌症研究所/波士顿儿童医院被诊断为胰腺炎的所有ALL患儿的临床病程。将这些患者的预后与未发生胰腺炎的ALL患者的预后进行比较。
403名儿童中有28名（7%）被诊断为胰腺炎。诊断时年龄在10 - 18岁的患者发生胰腺炎的风险是较年轻患者的2.4倍。胰腺炎通常发生在治疗过程早期（首次使用天冬酰胺酶后中位时间为4周）。93%的受影响患者住院，57%接受肠外营养。没有患者因胰腺炎发展为慢性后遗症或死亡。16名（57%）患者再次接受天冬酰胺酶治疗，其中10名又发生了一次胰腺炎。比较有和没有胰腺炎病史的患者时，无事件生存方面未观察到显著差异。
天冬酰胺酶相关胰腺炎在年龄较大的儿童中更常见，并导致显著的急性发病率。它往往在最初几剂天冬酰胺酶后发生，提示对这种并发症有易感性而非累积药物效应。胰腺炎发作后再次使用天冬酰胺酶与胰腺炎复发的高风险相关。
