The Effect of Combination of Steroid and L-Asparaginase on Hyperglycemia in Children with Acute Lymphoblastic Leukemia (ALL)

Document Type: Research Articles

Authors

1 Department of Pediatric Hematology Oncology, Indonesian National Cancer Center “Dharmais” Cancer Hospital, Jakarta, Indonesia.

2 Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

Abstract

Background: Hyperglycaemia is a common side effect of steroid and L-asparaginase combinations, occurring most
often during acute lymphoblastic leukemia (ALL) induction phase. To date in Indonesia, it has not been obtained data
on the incidence of hyperglycemia in children with ALL in the induction phase and how the role of combinations of
L-asparaginase and different type of steroid used. The purpose of this study is to determine the incidence of hyperglycemia
in children ALL induction phase, knowing the difference between prednisone and dexamethasone (in combination with
L-asparaginase) in causing hyperglycemia in children with ALL and determine the relationship of other factors related
to hyperglycaemia. Methods: This was a prospective analytic study with a pre- and post-test design, conducted in
three hospitals (Cipto Mangunkusumo Hospital, Dharmais Cancer Hospital, and Gatot Soebroto Hospital). Patient’s
blood glucose levels were checked at the 3rd (pretest), 4th, 5th and 6th week of protocol (post-test). Result: Of the
57 patients, 5.26% had hyperglycemia. The patients’ age ranged from 1.4 years old to 15.8 years old (6.7 years old).
There was no relationship between age, CNS infiltration, leukocytosis, Down syndrome, nutritional status, family
history of diabetes, infections and ALL stratification with hyperglycemia (p>0.05). Dexamethasone has more chance
of obtaining higher mean rate of change in blood glucose levels compared to prednisone. (p < 0.05; RR 10.68; CI 95%
1.52-74.73). Conclusion: The incidence of hyperglycemia in this study is 5.26%. Dexamethasone, in combination
with L-asparaginase, despite having no difference in causing hyperglycemia, has an increased risk of changing blood
glucose levels compared to prednisone.

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Volume 20, Issue 9
September 2019
Pages 2619-2624
  • Receive Date: 15 October 2018
  • Revise Date: 03 September 2019
  • Accept Date: 13 September 2019