[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-448265-105":59,"doc-detail-448265-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","asparaginase-associated-pancreatitis-during-therapy-for-pediatric-acute-lymphoblastic-leukemia-letter-to-the-editor","Asparaginase-associated pancreatitis during therapy for pediatric acute lymphoblastic leukemia - Letter to the Editor","","Letter to the editor reporting the frequency, timing, severity, predictors, and clinical impact of asparaginase-associated pancreatitis (AAP) in children treated for newly diagnosed acute lymphoblastic leukemia (ALL) on Total Therapy XVI. Using retrospective trial data, AAP was defined by CT/ultrasound findings, marked enzyme elevation, pancreatitis-characteristic pain, and occurrence within 35 days of asparaginase. Pancreatitis occurred in 57/586 patients with 80 episodes, was often grade 2–4, required prolonged hospitalization and intensive care, and showed associations with older age, standard/high-risk therapy, Hispanic ancestry, and elevated BMI.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/asparaginase-associated-pancreatitis-during-therapy-for-pediatric-acute-lymphoblastic-leukemia-letter-to-the-editor/448265/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/asparaginase-associated-pancreatitis-during-therapy-for-pediatric-acute-lymphoblastic-leukemia-letter-to-the-editor/448265.png","ImageObject",300,407,{"name":92,"@type":93},"Rowan","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-05","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"How common is asparaginase-associated pancreatitis during pediatric ALL therapy?","Question",{"text":112,"@type":113},"Pancreatitis occurred in 57 of 586 patients (9.7%) and resulted in 80 discrete episodes. The first episode arose a median of 195 days into therapy.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How did the study define AAP and decide when it counted?",{"text":117,"@type":113},"Symptomatic pancreatitis required at least two of three diagnostic criteria (imaging inflammation, amylase and/or lipase ≥3× ULN, and pancreatitis-characteristic pain). Episodes were classified as AAP if they occurred within 35 days of asparaginase therapy.",{"name":119,"@type":110,"acceptedAnswer":120},"What factors were associated with higher AAP risk?",{"text":121,"@type":113},"AAP occurred more often in older patients, in standard/high-risk therapy, in children of Hispanic ancestry, and in those with elevated BMI. Multivariable analyses additionally associated standard/high-risk therapy and mixed/other ancestry with AAP.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},448265,1790816174,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},1099514067415,"https://ap-avatar.wpscdn.com/avatar/100002539d78ffe74a7?x-image-process=image/resize,m_fixed,w_180,h_180&k=1779092875211072502","LETTER TO THE EDITOR  \nAsparaginase-associated pancreatitis during therapy for pediatric acute lymphoblastic leukemia  \nApproximately 90% of children with acute lymphoblastic leukemia (ALL) become long-term survivors utilizing asparaginase-containing regimens 1,2 However, asparaginase-associated pancreatitis (AAP) occurs in 1-7.4% of ALL patients during therapy.3,4 AAP occurs early in therapy (after a median of 3-5 doses),5,6 and most cases are severe: approximately two-thirds meet systemic inflammatory response syndrome (SIRS) criteria acutely7 or progress to pancreatic necrosis or pseudocyst as the AAP resolves. Pseudocyst developed in up to 60% of patients, with an overall average of 26% across multiple groups in a large international study.8 One recent study demonstrated that 17 of 43 patients (39.5%) with AAP developed organ failure or pancreatic necrosis, including necrosis within the first week in 12 (27.9%).9 Understanding AAP is critical for clinical decision-making in the context of ongoing leukemia-directed therapy. Re-exposure to asparaginase is frequently desired, as asparaginase truncation can increase the risk of relapse 10 Re-exposure is generally only considered in patients whose pancreatic enzymes rapidly normalize and who do not develop either apseudocyst or pancreatic necrosis 11 Despite this, recurrent pancreatitis occurs in half of patients.8  \nTo understand predictors and consequences of severe AAP, we retrospectively reviewed patient-level data in patients treated for newly diagnosed ALL on the Total Therapy XVI trial ([clinicaltrials.gov](clinicaltrials.gov) NCT00549848)1 Children \u003C19 years of age at diagnosis received 1-2 doses of PEG-asparaginase during induction. Patients subsequently received 4 (low-risk) or 15 (standard/high-risk) post-inductions doses of PEG-asparaginase during the first 30 weeks of continuation therapy. Infants \u003C1 year of age at diagnosis received modified therapy and were excluded from the current study. All patients and/or their families provided informed consent/assent in alignment with the Declaration of Helsinki. The institutional review board approved all studies.  \nThe protocol adverse events database was reviewed to identify patients who experienced symptomatic pancreatitis (Common Terminology Criteria for Adverse Events [CTCAE] v3 grade 2 or higher, equivalent to CTCAE v5 grade 3 or higher). Pancreatitis required at least 2 of 3 diagnostic criteria: imaging evidence of pancreatic inflammation, amylase and/or lipase ≥3 times the laboratory upper limit of normal (ULN), and pain characteristic of pancreatitis. Pancreatitis was categorized as AAP if it occurred within 35 days of asparaginase therapy. All patients with computed tomography (CT) or ultrasound (US) available after the incident pancreatitis episode had imaging reviewed by a single pediatric radiologist (MBM).  \nStatistical analyses were performed in R. The cumulative incidence of pancreatitis was calculated using the Kalb-  \nfleisch-Prentice method with the first episode as an event and non-pancreatitis toxic death, relapse, and second malignancy considered as competing risks. In analysis of AAP risk, other pancreatitis episodes were treated as non-events. The impact of pancreatitis on event-free survival (EFS) was calculated using Cox proportional hazard regressions with survival censored at last follow-up.  \nPancreatitis occurred in 57 of 586 patients (9.7%), who experienced a total of 80 discrete episodes. The first episode of pancreatitis occurred a median of 195 days into therapy (interquartile range: 112-236 days) with 1-year and 3-year cumulative incidences of 9.4% and 9.7%, respectively. Forty-seven (59%) episodes were classified as grade 2, 27 (34%) as grade 3, 5 (6%) as grade 4, and one resulted in death (grade 5). This fatality followed a prolonged hospitalization with multiorgan failure and was discovered post-mortem; pancreatitis was diagnosed >35 days from this patient’s 5th dose of asparaginase th","cbCaifd9R4dzJAUN","https://ap.wps.com/l/cbCaifd9R4dzJAUN","pdf",927109,"English","# Methods and patient selection\n# Definition and imaging review\n# Statistical analysis\n# Incidence, severity, and timing\n# Recurrence and rechallenge outcomes\n# Predictors and subgroup associations","[{\"question\":\"How common is asparaginase-associated pancreatitis during pediatric ALL therapy?\",\"answer\":\"Pancreatitis occurred in 57 of 586 patients (9.7%) and resulted in 80 discrete episodes. The first episode arose a median of 195 days into therapy.\"},{\"question\":\"How did the study define AAP and decide when it counted?\",\"answer\":\"Symptomatic pancreatitis required at least two of three diagnostic criteria (imaging inflammation, amylase and/or lipase ≥3× ULN, and pancreatitis-characteristic pain). Episodes were classified as AAP if they occurred within 35 days of asparaginase therapy.\"},{\"question\":\"What factors were associated with higher AAP risk?\",\"answer\":\"AAP occurred more often in older patients, in standard/high-risk therapy, in children of Hispanic ancestry, and in those with elevated BMI. Multivariable analyses additionally associated standard/high-risk therapy and mixed/other ancestry with AAP.\"}]","Asparaginase-associated pancreatitis during therapy for pediatric acute lymphoblastic leukemia - Letter to the Editor | PDF",1790726336,13]