Severe asparaginase-associated hypertriglyceridemia in pediatric acute lymphoblastic leukemia: a single-center experience
Abstract
Background: Asparaginase-associated hypertriglyceridemia (AAHTG) is a recognized metabolic complication of asparaginase therapy in pediatric acute lymphoblastic leukemia (ALL). However, data on its incidence, clinical presentation, and optimal management remain limited.
Methods: We performed a retrospective analysis of 12 pediatric patients (≤18 years) with ALL treated at King Hussein Cancer Center (KHCC) between January 2021 and February 2026 who developed severe AAHTG, defined as triglyceride levels >1,000 mg/dL following asparaginase administration. Clinical characteristics, management strategies, and outcomes were systematically reviewed and analyzed.
Results: Among 598 patients with pediatric ALL treated at KHCC, 12 developed severe AAHTG (incidence 2%). Most cases (83%) were asymptomatic and identified incidentally through observation of lipemic serum on routine laboratory testing; only two patients were symptomatic-one with acute pancreatitis and one with hyperviscosity syndrome. The median age was 9.5 years, with a male predominance (83%). Most patients had B-cell ALL (75%) and high-risk disease (66%). AAHTG occurred predominantly during the maintenance phase (66%), with a median onset of 12 days after the last asparaginase dose. The median peak triglyceride level was 2,645 mg/dL (range, 2,052-6,687 mg/dL). All patients received intravenous fluids, omega-3 fatty acids, and fibrates. Continuous insulin infusion was administered in 11 patients over a median of 3 days…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 598 participants or records.
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