Treepongkaruna Suporn, Thongpak Naporn, Pakakasama Samart, Pienvichit Paneeya, Sirachainan Nongnuch, Hongeng Suradej
Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Pediatr Hematol Oncol. 2009 Nov;31(11):812-5. doi: 10.1097/MPH.0b013e3181b87035.
Acute pancreatitis (AP) is a complication in children with acute lymphoblastic leukemia (ALL) receiving chemotherapy and has often been reported associated with L-asparaginase (L-asp) therapy.
To determine the incidence, risk factors, clinical data, outcome, and mortality of AP in children with ALL.
Retrospective cohort study was conducted by reviewing the data of total 192 pediatric ALL patients from Pediatric Oncology Registry at Ramathibodi Hospital from 2000 to 2006 to assess incidence, clinical data, outcome, and mortality of AP. Then, a nested case-control study was conducted to identify potential risk factors for AP by recruiting all patients with AP as cases (n=16), and randomly selected patients without AP to serve as controls up to approximately four controls per case with the total of 68 controls.
The total incidence of AP in children with ALL and L-asp-associated AP was 8.3% and 7.3%, respectively. In patients with L-asp-associated AP, pancreatitis developed after the median 5.5 doses (range: 1 to 20 doses) of L-asp therapy and the median interval from the last dose of L-asp to the onset of AP was 4 days (range: 1 to 13 days). The mortality rate of AP group was significantly higher than the patients without AP (43.8% vs. 19.3%, P=0.02). Mortality was associated with concurrent systemic infection and complications of underlying diseases. Multivariate analysis identified using a high-risk chemotherapy regimen was the only risk factor for AP.
Using a high-risk chemotherapy regimen was a risk factor for pancreatitis in patients with ALL. ALL children with AP had higher mortality rate than those without pancreatitis.
急性胰腺炎（AP）是接受化疗的急性淋巴细胞白血病（ALL）患儿的一种并发症，且经常有报道称其与左旋门冬酰胺酶（L-asp）治疗相关。
确定ALL患儿中AP的发病率、危险因素、临床数据、结局及死亡率。
通过回顾2000年至2006年拉玛蒂博迪医院儿科肿瘤登记处的192例儿科ALL患者的数据进行回顾性队列研究，以评估AP的发病率、临床数据、结局及死亡率。然后，进行一项巢式病例对照研究，通过将所有AP患者作为病例（n = 16），并随机选择无AP的患者作为对照，每个病例约选4名对照，共68名对照，以确定AP的潜在危险因素。
ALL患儿中AP的总发病率和L-asp相关AP的发病率分别为8.3%和7.3%。在L-asp相关AP患者中，胰腺炎在L-asp治疗的中位5.5剂（范围：1至20剂）后发生，从最后一剂L-asp到AP发作的中位间隔为4天（范围：1至13天）。AP组的死亡率显著高于无AP的患者（43.8%对19.3%，P = 0.02）。死亡率与并发全身感染和基础疾病并发症相关。多因素分析确定使用高风险化疗方案是AP的唯一危险因素。
使用高风险化疗方案是ALL患者发生胰腺炎的危险因素。患有AP的ALL儿童的死亡率高于未患胰腺炎的儿童。
