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Recurrent Hypoglycemia Following Asparaginase Therapy for Lymphoid Malignancies in Childhood: The Texas Children’s Hospital Experience
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  • Manal Y. Tantoush,
  • Alfonso Hoyos-Martínez,
  • Michael Scheurer,
  • Mackenzie Frederick,
  • Judith Margolin,
  • Joanna Yi,
  • Vince Horne
Manal Y. Tantoush
Texas Children's Hospital
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Alfonso Hoyos-Martínez
Texas Children's Hospital
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Michael Scheurer
Texas Children's Cancer Center and Hematology Centers
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Mackenzie Frederick
Texas Children's Cancer Center and Hematology Centers
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Judith Margolin
Texas Children's Cancer Center and Hematology Centers
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Joanna Yi
Texas Children's Cancer Center and Hematology Centers

Corresponding Author:jsyi@txch.org

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Vince Horne
Texas Children's Hospital
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Abstract

Background: Hypoglycemia is a rarely reported complication of Asparaginase (ASP) therapy in children with lymphoblastic leukemia/lymphoma (ALL/LLy). We sought to identify risk factors and outcomes among patients with ASP-induced hypoglycemia (AIH) at our institution. Methods: Retrospective cohort study using electronic medical records to identify all patients who received ASP and had diagnosis of hypoglycemia between 6/1/2017-6/30/2022. Demographic and clinically relevant data were collected. Results: A total of 672 patients received ASP, with 8% having AIH–defined by a measured low blood glucose level within 14 days of ASP administration and other causes of hypoglycemia excluded. Median age at ALL/LLy diagnosis was 4.4 years (Interquartile range [IQR]: 2.5 – 7.7) which was younger than patients without AIH (median 6.9 years, p-value 0.005), and median BMI z-score 0.50 (IQR: -0.46 – 0.95). Initial hypoglycemia event was during Induction therapy in 71%, with median time from ASP to hypoglycemia diagnosis of 11 days (IQR: 6-15). Median duration of the hypoglycemia episode was 11 days (IQR: 7-19). Recurrent hypoglycemia with subsequent ASP doses occurred in 84% of patients, with a median duration 14 days (IQR: 8-21). Overall survival of the AIH cohort was 80% (85% if limited to patients with newly diagnosed ALL/LLy), with 3 years’ median follow up. In univariate analysis, hypoglycemia severity was not associated with age, sex, ethnicity, or weight. Conclusion: AIH is relatively common with no clear risk factors besides younger age. It can recur and become more severe with longer duration. AIH screening and management should be implemented.
30 Sep 2024Submitted to Pediatric Blood & Cancer
30 Sep 2024Submission Checks Completed
30 Sep 2024Assigned to Editor
01 Oct 2024Review(s) Completed, Editorial Evaluation Pending
08 Oct 2024Reviewer(s) Assigned