Retrospective analysis of asparaginase-associated pancreatitis in pediatric acute lymphoblastic leukemia: focus on rechallenge with pegaspargase.

Purpose: The incidence of asparaginase-associated pancreatitis (AAP) in children with acute lymphoblastic leukemia (ALL) may lead to treatment delays and insufficient drug exposure, thereby increasing the risk of ALL relapse. We aimed to understand the clinical characteristics and management of AAP, which are crucial for improving treatment outcomes in children with ALL.

Methods: We retrospectively analyzed the medical records of children diagnosed with AAP and admitted to Hebei Children's Hospital between April 2019 and July 2024. We analyzed the clinical characteristics and management strategies of AAP in children with ALL, with a particular focus on the treatment strategies and AAP recurrence in children who were rechallenged with pegaspargase (PEG-ASP).

Results: Among 474 patients treated for ALL, 32 were diagnosed with AAP (incidence rate, 6.8%). Of these 32 cases, mild pancreatitis accounted for 50.0% (16/32), moderately severe pancreatitis for 43.8% (14/32), and severe pancreatitis for 6.3% (2/32). AAP occurred most frequently during the induction and early intensive therapy phases. The median time to onset of AAP was 10.5 (1-26) days, and the median number of PEG-ASP doses administered was three (range 1-11). Notably, 53.1% (17/32) patients were rechallenged with PEG-ASP, of whom seven experienced AAP recurrence, including one with three episodes. Despite these statuses, all patients either recovered or showed improvement in their disease status, and no mortality was reported.

Conclusion: AAP in children with ALL can be effectively managed through early detection and appropriate treatment. Rechallenge with PEG-ASP should be individualized to balance the risk of recurrence against the benefits of continued therapy.