Acute Pancreatitis Complicating L-asparaginase Therapy in Pediatric Oncology: A Case Report.

Authors

Loubna Larda, Karima Ryouni, Elouassifi Kawtar, El Alaoui Mounia, Noufissa Benajiba

Published in

Cureus. Volume 18. Issue 6. Pages e111138. Epub Jun 19, 2026.

Abstract

Acute pancreatitis is a recognized toxicity of L-asparaginase therapy during the treatment of pediatric acute lymphoblastic leukemia (ALL). Its management requires a delicate balance between avoiding leukemic relapse and preventing pancreatic recurrence. We report the case of a five-year-and-eight-month-old girl with Philadelphia chromosome-positive B-cell ALL, initially treated with imatinib combined with the high-risk MARALL 2006 protocol, and subsequently with the COOPRALL 97 protocol following an isolated central nervous system relapse. Seventy-two hours after the 18th cumulative administration of L-asparaginase, she developed epigastric pain and vomiting. Serum lipase was greater than three times the upper limit of normal, confirming the diagnosis of acute pancreatitis. The episode was classified as grade 2 according to the Ponte di Legno group classification. After clinical and biological resolution of pancreatitis, L-asparaginase was reintroduced because of the patient's high-risk relapsed leukemia. After 10 weeks of follow-up after reintroduction, no recurrence was observed. This case supports the feasibility of L-asparaginase rechallenge in selected high-risk pediatric patients following a multidisciplinary risk-benefit assessment.

PMID:
42473481
Bibliographic data and abstract were imported from PubMed on 20 Jul 2026.

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