Steinherz P G
Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
Cancer. 1994 Dec 15;74(12):3234-9. doi: 10.1002/1097-0142(19941215)74:12<3234::aid-cncr2820741224>3.0.co;2-1.
Corticosteroids and asparaginase inhibit protein synthesis. Many of their side effects are familiar to oncologists. Conversely, the possibility of therapy-induced hyperlipidemia generally is not appreciated. The incidence of severe hyperlipidemia during therapy of patients with acute lymphoblastic leukemia (ALL) who received prednisone and asparaginase was evaluated.
During therapy with prednisone and asparaginase, a 10-year-old girl with precursor B ALL was identified with a peak plasma triglyceride and cholesterol level of 20,600 mg/dl and 1640 mg/dl, respectively. The lipid profile of the 60 patients in the protocol with this patient, the lipid profile of 64 patients on the previous high-risk ALL therapy program, and the literature were reviewed.
Five of 60 patients on the New York-II protocol experienced transient, marked (triglyceride level > or = 1000 mg/dl), benign hyperlipidemia. No such problem was observed in the 64 patients on the New York-I protocol. Five similar cases were found in the literature during therapy with steroids (2), asparaginase (2), or both (1). There were no characteristics that distinguished these 10 patients from the vast majority of patients on similar therapy without severe hyperlipidemia. Prolonged therapy with either agent seemed to increase the possibility of hyperlipidemia.
Severe hyperlipidemia during induction therapy for ALL is random, transient, and benign. Given the serious nature of the underlying disorder and the value of asparaginase and prednisone in its treatment, antileukemic therapy should not be modified when severe hyperlipidemia is observed.
皮质类固醇和天冬酰胺酶可抑制蛋白质合成。肿瘤学家对它们的许多副作用都很熟悉。相反，治疗引起的高脂血症的可能性通常未得到重视。对接受泼尼松和天冬酰胺酶治疗的急性淋巴细胞白血病（ALL）患者治疗期间严重高脂血症的发生率进行了评估。
在使用泼尼松和天冬酰胺酶治疗期间，一名患有前体B-ALL的10岁女孩被发现血浆甘油三酯和胆固醇水平峰值分别为20,600mg/dl和1640mg/dl。回顾了该方案中与该患者一起的60例患者的血脂情况、之前高危ALL治疗方案中64例患者的血脂情况以及相关文献。
纽约-II方案的60例患者中有5例出现短暂性、明显（甘油三酯水平≥1000mg/dl）的良性高脂血症。纽约-I方案的64例患者中未观察到此类问题。在文献中发现5例类似病例，分别在使用类固醇（2例）、天冬酰胺酶（2例）或两者（1例）治疗期间。这10例患者与绝大多数接受类似治疗但无严重高脂血症的患者没有区别特征。两种药物的长期治疗似乎都增加了高脂血症的可能性。
ALL诱导治疗期间的严重高脂血症是随机、短暂且良性的。鉴于基础疾病的严重性以及天冬酰胺酶和泼尼松在其治疗中的价值，当观察到严重高脂血症时，不应改变抗白血病治疗。
