陈辉, 陈森. 儿童急性淋巴细胞白血病并发急性胰腺炎的临床特点分析[J]. 中国肿瘤临床, 2020, 47(13): 666-669. DOI: 10.3969/j.issn.1000-8179.2020.13.314
引用本文: 陈辉, 陈森. 儿童急性淋巴细胞白血病并发急性胰腺炎的临床特点分析[J]. 中国肿瘤临床, 2020, 47(13): 666-669. DOI: 10.3969/j.issn.1000-8179.2020.13.314
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Chen Hui, Chen Sen. Clinical characteristics of children with acute lymphoblastic leukemia presenting with secondary acute pancreatitis[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2020, 47(13): 666-669. DOI: 10.3969/j.issn.1000-8179.2020.13.314
Citation: Chen Hui, Chen Sen. Clinical characteristics of children with acute lymphoblastic leukemia presenting with secondary acute pancreatitis[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2020, 47(13): 666-669. DOI: 10.3969/j.issn.1000-8179.2020.13.314
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儿童急性淋巴细胞白血病并发急性胰腺炎的临床特点分析

Clinical characteristics of children with acute lymphoblastic leukemia presenting with secondary acute pancreatitis

    摘要
  • 摘要:
      目的  分析儿童急性淋巴细胞白血病（acute lymphoblastic leukemia，ALL）并发急性胰腺炎（acute pancreatitis，AP）患儿的临床特点。
      方法  收集2013年2月至2020年2月天津市儿童医院收治的ALL并发AP患儿11例，均采用中国儿童白血病协作组-急性淋巴细胞白血病-2008（CCLG-ALL 2008）方案联合化疗，总结患儿的危险度分层、主要临床表现、发生胰腺炎的所处治疗阶段、发病原因、培门冬酶（polyethylene glycol conjugated asparaginase，PEG-ASP）的累积用量，整理患儿的胰酶指标、影像学检查、血常规、肝肾功能、血脂血糖、凝血功能等化验结果，对比患儿治疗效果及转归，分析其临床特点。
      结果  全组11例患儿中，男性7例，女性4例，年龄范围1~14岁，中位年龄6岁；急性B淋巴细胞白血病（type B acute lymphoblastic leukemia，B-ALL）10例，急性T细胞型淋巴母细胞白血病（type T acute lymphoblastic leukemia，T-ALL）1例；初始联合化疗开始45天内发病8例，高危患儿第二循环HR3'化疗后发病1例，延迟强化化疗后发病2例，PEG-ASP治疗后发病10例，T-ALL伴肿瘤溶解综合征予环磷酰胺+地塞米松减积治疗后发病1例。11例患儿主要表现均为腹痛、恶心、呕吐，低钙血症8例，白蛋白水平下降9例，凝血功能异常8例，无超敏反应发生。
      结论  儿童ALL并发AP多在联合化疗早期发生，多为门冬酰胺酶治疗相关并发症，病情轻重与疾病危险度、PEG-ASP累积使用量无明显关联，监测胰酶及影像学检查有助于评估病情，指导后期用药。

     

    Abstract:
      Objective   To analyze the clinical characteristics of children with acute lymphoblastic leukemia (ALL) diagnosed with secondary acute pancreatitis(AP).
      Methods   We collected data from a total of 11 patients with ALL and secondary acute pancreatitis who were treated in Tianjin Children's Hospital from February 2013 to February 2020. All patients followed the China Children's Leukemia Collaborative GroupAcute Lymphocytic Leukemia-2008 (CCLG- ALL 2008) combined regimen. We summarized the patient's risk stratification, primary clinical manifestations, treatment stage, cause of pancreatitis, and cumulative dosage of polyethylene glycol conjugated asparaginase (PEG-ASP). The results from examinations such as pancreatic enzyme index, imaging, blood routine, liver and kidney function, blood lipid and blood glucose, and coagulation function were also compared. Finally, the therapeutic effects and outcomes of the patients were compared; and subsequently their clinical characteristics were analyzed.
      Results   Among the 11 patients 7 were male, and 4 were female; aged between 1-14 years old, with a median age of 6 years. Ten patients had type B acute lymphoblastic leukemia (B-ALL) and 1 had type T acute lymphoblastic leukemia (T-ALL). Pancreatitis was observed in 8 cases within 45 days after start of therapy, in one high-risk case after the second cycle of HR3' chemotherapy and in 2 cases after intensive chemotherapy. It was observed in 10 cases after PEG-ASP treatment, and in one T-ALL case concomitant with tumor lysis syndrome following cyclophosphamide-dexamethasone cytoduction treatment. It manifested primarily as abdominal pain, nausea and vomiting in 11 patients; 8 patients had hypocalcemia; 9 patients had low albumin levels; and 8 patients had abnormal coagulation function. No hypersensitivity was observed.
      Conclusions   Secondary AP occurs in children with ALL during the early stages of combined chemotherapy. Most of the complications are related to the asparaginase treatment. The severity of the disease is not significantly correlated with the risk stratification of the disease and the cumulative dose of asparaginase. Serum pancreatic enzyme (PE) testing and imaging tests can help assess the clinical status and guide the later prognosis and medication.

     

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