39 Hypoglycemia during treatment of acute lymphoblastic leukemia – A Canadian Paediatric Surveillance Program Study
Bibliographic record
Abstract
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.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".