Targetable Factors for Prevention of Hypoglycemic Events in Pediatric Acute Lymphoblastic Leukemia Patients




Sahu, Ayushi
Sharma, Ishna


0000-0002-1396-1754 (Sharma, Ishna)

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Purpose: Hypoglycemia is a thought-to-be rare complication of 6-mercaptopurine (6MP), a drug used in pediatric acute lymphoblastic leukemia (ALL) treatments. However, there is little data on hypoglycemia prevalence during treatment with 6-MP and/or other risk factors. Through this study, we aim to evaluate the epidemiology and risk factors that contribute to hypoglycemia during ALL therapy within the pediatric patients group. Methods: ALL patients ≤18 years of age, who actively received therapy between 2010 and 2017, were retrospectively reviewed. Data included age, sex, number of hypoglycemic episodes, blood sugar levels, scheduled procedure days pre- and post- maintenance, fasting duration, and thiopurine methyltransferase (TMPT) genotype. Patients were considered hypoglycemic if at least one glucose measurement was < 60 mg/dL. Results: Eighty-six patients met inclusion criteria, 41 (47.7%) in the normoglycemic and 45 (52.3%) in the hypoglycemia subgroups. Maintenance therapy decreased risk of developing hypoglycemic episodes (RR=0.749, p=0.0001). Procedure days (e.g., prolonged fasting) increased the risk of hypoglycemic events both before (RR=1.8378, p=0.0035) and during (RR=1.70, p=0.0005) the maintenance phase. Indeed, procedure days increased the risk of experiencing severe mean blood glucose levels by 1.56 (RR=1.56, p=0.3454). Those ≤6 years of age had 1.74 times increased risk of experiencing hypoglycemic during treatment (RR=1.7421, p=0.0357). Conclusion: Prevalence of hypoglycemic events among pediatric patients receiving ALL therapy is greater than previously thought. Often, these episodes go unnoticed and thus are not treated. Providers, patients, and caregivers should be educated on hypoglycemic complications resulting from ALL therapy and tailor vigilance for episodes based on age and fasting length.