39 Hypoglycemia during treatment of acute lymphoblastic leukemia – A Canadian Paediatric Surveillance Program Study
Notice bibliographique
Résumé
Abstract Background An important but under-recognized adverse drug reaction (ADR) associated with acute lymphoblastic leukemia (ALL) treatment is hypoglycemia, which can lead to significant morbidity. There are reports of hypoglycemia associated with asparaginase and 6-mercaptopurine (6MP), which are commonly used in ALL protocols. The association, mechanism, and temporal relationship between these agents and hypoglycemic events are not well described. A national Canadian Paediatric Surveillance Program (CPSP) study was completed to further understand this rare ADR. Objectives The objectives were to assess the association, mechanism, and temporal relationship between ALL treatment and hypoglycemic events. Design/Methods Through CPSP methodology, a network of paediatricians and paediatric subspecialists, participants were asked monthly to report patients less than 18 years old with a first known episode of biochemically proven hypoglycemia (<3 mmol/L) during ALL therapy from October 2022–September 2024. Descriptive analysis was completed for demographics, timing of onset and duration of hypoglycemia, and management. Results Fifteen patients were reported and met criteria. Median age was 5.31 (IQR 2.67,7.83) years. Median BMI percentile was 43% (27,98). Six patients were female (40%). Median initial blood glucose value was 2.95 (2.75,3.10) mmol/L. Seven (47%) patients had symptoms including altered level of consciousness, seizure, tremor/jitteriness, diaphoresis, hunger, fatigue, dizziness, and nausea. Presentations of hypoglycemia occurred primarily at tertiary centers (73%), although some presentations occurred at non-tertiary centers and at home. Nine (60%) patients had hypoglycemia within 40 days of pegylated (PEG)-asparaginase exposure; onset ranged from 9-38 days (median 17) after most recent exposure. Of those with a critical sample, 100% were hypoketotic. Six (40%) patients had hypoglycemia within seven days of 6MP completion. Onset of hypoglycemia ranged from 2-697 days (median 51) from initiation of the most recent 6MP course. Almost none of these patients had a critical sample. Fourteen (93%) patients needed treatment for hypoglycemia, including intravenous dextrose, enteral glucose, cornstarch, insulin dose reduction (in a patient with diabetes), and adjusted timing of 6MP. At the time of reporting, six (43%) patients were receiving ongoing treatment and eight (57%) patients had concluded treatment for hypoglycemia; median treatment duration for the latter group was two days (range 1-8). Conclusion Although the frequency of hypoglycemia was rare, almost half of patients were symptomatic and almost all required treatment. PEG-asparaginase was associated with hypoketotic hypoglycemia, suggesting hyperinsulinism. This study highlights the need for increased awareness of this potential treatment complication and provides insight into mechanisms to help inform treatment.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,005 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».