Objective  To analyze the clinical characteristics and risk factors of asparaginase-associated pancreatitis (AAP) in children with acute lymphoblastic leukemia (ALL), and to investigate the impact of AAP on their prognosis following re-exposure to asparaginase (ASP).

Methods  Clinical children data with ALL at Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology between January 2015 and June 2020 were collected to analyze the clinical features of AAP. Logistic regression was used to identify risk factors for AAP. Prognostic analysis was performed using the Log-rank test and Kaplan–Meier survival curves.

Results  Overall, 252 children with ALL were included, among whom 23(9.1%) developed AAP. Most AAP cases (82.6%) occurred during remission induction, with a median time from the last ASP to AAP of 12 d. Elevated total cholesterol (≥3.5 mmol/L) at initial diagnosis was identified as an independent risk factor. Six children (26.1%) were re-exposed to ASP, leading to recurrent pancreatitis in 3 cases. The 5-year overall survival (OS) was significantly lower in the AAP group (78.3%±8.6%) compared to the non-AAP group (90.3%±2.2%) (P<0.05). Similarly, children who discontinued ASP due to AAP had a 5-year OS of 77.8%±9.8%, significantly lower than the control group (90.1%±2.1%).

Conclusions  AAP typically occurred within 12 d of the last ASP administration and was associated with poorer 5-year OS. Re-exposure to ASP posed a risk of recurrent AAP; however, completing the ASP chemotherapy regimen may be crucial for improving prognosis.