A nomogram for acute pancreatitis in patients with acute lymphoblastic
leukemia under CCLG-ALL regimen
Abstract
Introduction: Acute lymphoblastic leukemia (ALL) is the most common
malignant neoplasm in children. Although the prognosis is good,
complications caused by chemotherapy are still a large challenge for
clinicians. Among them, pancreatitis is one of the most serious
complications after the application of asparaginase, which is an
important part of treatment. The occurrence of pancreatitis may affect
chemotherapy tolerance and prognosis of ALL. We intend to establish a
predictive model for the risk of pancreatitis in children with ALL
during chemotherapy based on clinical data. Method: Collect clinical
data of ALL patients under CCLG-ALL, screen variables that may be
related to the occurrence of pancreatitis through lasso regression,
divide the total patient into a training set and a validation set in a
ratio of 8:2, build a prediction model in the training set, and evaluate
prediction ability through area under the receiver operating
characteristic curve (AUC) and calibration curve. External validation is
done in the validation set. Results: A total of 321 patients with ALL
were included in this study, including 58 patients with pancreatitis and
263 patients in the control group. Risk factors related to pancreatitis
were elevated total bilirubin, direct bilirubin and induction
chemotherapy. C statistic and AUC obtained in the training set of this
model was 0.862 and 0.86, and the AUC of this model in the validation
set was 0.95. Conclusion: This study constructs a risk prediction model
for pancreatitis in children with acute lymphoblastic leukemia receiving
chemotherapy, and the results suggest that the prediction ability is
good. A nomogram based on this model was developed. Among the risk
factors, increased total bilirubin and direct bilirubin may indicate
that pancreatitis may be related to biliary obstruction, and induction
chemotherapy may indicate that children may have predisposing factors
for pancreatitis. Further research may be needed in these two aspects in
the future.