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

Abstract

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