Clinical Features of Pancreatitis in Children with Leukemia and Lymphoma

Park, Jun Eun; Kim, Kyong Mo; Seo, Jong Jin; Moon, Hyung Nam; Ghim, Thad

Abstract

PURPOSE: The aim of this study was to review the clinical characteristics and treatment outcome of pancreatitis developed in 19 children with leukemia and lymphoma in Asan Medical Center.
METHODS
Hospital and outpatient records of 19 children either with leukemia or lymphoma who developed acute pancreatitis were reviewed. Clinical characteristics of these patients along with serologic data were analysed.
RESULTS
1. Median age at diagnosis of pancreatitis in 19 patients was 11 years of age. 2. Patients had acute lymphocytic leukemia (12 cases; 53%), acute myelocytic leukemia (4 cases; 21%), non-Hodgkins lymphoma (3 cases; 16%). 3. The etiologies of pancreatitis were L-asparaginase (16 cases) therapy, continuous Ara-C therapy (2 cases) and gallbladder stone (1 case). 5. L-asparaginase realated pancreatitis developed during the course of CCG 1882 induction (7 cases), CCG 1901 onsolidation (4 cases), CCG 1901 induction (1 case), and ADCOMP induction (1 case). 6. All patients experienced abdomial pain. Nausea, fever, vomiting, abdominal distention and diarrhea were also manifested clinically. 7. Hypocalcemia, sepsis, ascites, hyperglycemia, diabetic ketoacidosis, pancreatic pseudocysts and fistula were complicating events. 8. 6 patients were dead. The causes of death were from progression of lymphoma/ leukemia itself in 5 cases. One patient died of regimen related toxicity. The period of follow-up ranged from 2 months to 6.6 years with median follow-up of 28 months.
CONCLUSION
1. It is neccessary to monitor the level of serum amylase and lipase or to perform radiologic evaluation in patients who develop abdominal pain during L-asparaginase and Ara-C therapy especially in the course of CCG 1882 induction and CCG 1901 consolidation. 2. The outcome of chemotherapy induced pancreatitis is favorable in most instances but in some patients chronic pancreatitis may remain. The delay of chemotherapy due to pancreatitis may be responsible for the relapse of cancer. Therefore, prompt diagnosis and aggressive supportive therapy are important.