alexa Prospective Longitudinal Examination of Hyperammonemia during L-Asparaginase Treatment within 24 Hours after Administration in Childhood Lymphoblastic Malignancies
ISSN: 2329-6917

Journal of Leukemia
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Case Report

Prospective Longitudinal Examination of Hyperammonemia during L-Asparaginase Treatment within 24 Hours after Administration in Childhood Lymphoblastic Malignancies

Marios Paulides1#, Ronny Jung2#,Martin Chada3, Berthold Lausen4, Markus Metzler3 and Thorsten Langer5

1Drug Commission of the German Medical Association, Berlin, Germany

2Pediatrician, practioner, Roth, Germany

3University Hospital for Children and Adolescents, Erlangen, Germany

4Professor of Statistics, Department of Mathematical Sciences at University of Essex, UK

5University Hospital for Children and Adolescents, Lübeck, Germany

#These authors contributed equally to the study

*Corresponding Author:
Dr. Thorsten Langer
Paediatric Immunology and Oncology
University Hospital for Children and Adolescents
Loschgestrasse 15, 91054 Erlangen, Germany
Tel: +49-9131-85-33733
Fax: +49-9131-85-36286
E-mail: [email protected]

Received date May 16, 2013; Accepted date July 17, 2013; Published date July 19, 2013

Citation: Paulides M, Jung R, Chada M, Lausen B, Metzler M, et al. (2013) Prospective Longitudinal Examination of Hyperammonemia during L-Asparaginase Treatment within 24 Hours after Administration in Childhood Lymphoblastic Malignancies. J Leuk (Los Angel) 1:117. doi:10.4172/2329-6917.1000117

Copyright: © 2013 Paulides M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

L-asparaginase is used in virtually every protocol against acute lymphoblastic malignancies in induction and intensification. In rare cases, patients may develop hyperammonemia encephalopathy as a side-effect, resulting in severe neurologic deterioration and even death. After an index case at our hospital, we conducted prospective longitudinal examination of blood ammonia level kinetics in further six consecutively enrolled patients treated with E.coli L-asparaginase without neurological signs of encephalopathy within 24 hours after administration. All patients developed transient hyperammonemia above the potentially neurotoxic threshold of 60 μmol/l, with peak concentrations being reached 2 hours after L-asparaginase infusion at 144 μmol/l (range 62 -277 μmol/l). A decline to baseline values was observed after 24 hours. We conclude that transient hyperammonemia is frequent in children treated on protocols containing L-asparaginase. A further precipitating event may lead to hyperammonemia encephalopathy with neurologic symptoms. Therefore, all patients with neurologic symptoms during treatment with L-asparaginase should receive metabolic surveillance and blood ammonia examinations in addition to monitoring for infectious or cerebrovascular complications.

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