Table 3.
Episodes of severe hypertriglyceridemia
| Pt | Episode | Timing of therapy |
Preceding steroid, asp |
Peak TGL mg/dL |
Days until TGL <1000 mg/dL |
Symptoms | Abnormalities on laboratory tests |
Adverse event (time from peak TGL) |
Medications (duration in days) |
Subsequent asparaginase |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 1st 2nd |
Induction Day 24 Induction Day 32 |
Pred, peg-asp Pred |
1619 1127 |
3 1 |
Headache None |
HBS | Cerebral vasculitis (7 days pre) | Cholestyramine (12) Cholestyramine (continue) |
Yes Yes |
| 2* | 1st | Re-induction I Day 1 | Dex, peg-asp | 1573 | NA | Headache, nausea | – | Yes | ||
| 3* | 1st 2nd |
Re-induction II Day 1 Continuation, Week 25 |
Dex, peg-asp Peg-asp |
6630 1454 |
17 NA |
Fatigue, diarrhea, nausea Fatigue, diarrhea |
Transaminitis, hyponatremia HBS Transaminitis |
O-3 FA (74), Fibrate (21) O-3 FA (continue) |
Yes Yes |
|
| 4 | 1st | Re-induction II Day 1 | Dex, peg-asp | 1146 | NA | Diarrhea, abdominal pain | – | Yes | ||
| 5 | 1st 2nd 3rd |
Re-induction I Day 20 Continuation Week 14 Continuation Week 20 |
Dex, peg-asp Dex, peg-asp Dex, peg-asp |
3937 4897 1282 |
22 36 NA |
Fever, nausea, abdominal pain Abdominal pain None |
Hyponatremia Hyponatremia |
O-3 FA (7) Fibrate (30) – |
Yes Yes Yes |
|
| 6* | 1st | Re-induction I Day 12 | Dex, peg-asp | 3730 | 4 | Fatigue, headache | Transaminitis | Pancreatitis (56 days post) | – | Yes (stopped after pancreatitis) |
| 7* | 1st 2nd |
Induction Day 24 Continuation Week 5 |
Pred, peg-asp Dex, peg-asp |
5420 2062 |
16 2 |
Fatigue, emesis, diarrhea, abdominal pain Fatigue, diarrhea |
Hyponatremia, transaminitis Transaminitis |
O-3 FA (365), Fibrate (365) O-3 FA, Fibrate (continue) |
Yes Yes |
|
| 8 | 1st | Re-induction I Day 1 | Dex, peg-asp | 2709 | 19 | Fatigue, diarrhea, abdominal pain, headache, blurred vision | Transaminitis, hyponatremia | Pancreatitis (75 days post) | O-3 FA (30) | Yes (stopped after pancreatitis) |
| 9 | 1st 2nd |
Re-induction I Day 8 Re-induction II Day 1 |
Dex, peg-asp Dex, peg-asp |
1507 1729 |
42 7 |
None None |
O-3 FA (350) O-3 FA (continue), Fibrate (180) |
Yes Yes |
||
| 10* | 1st | Re-induction I Day 1 | Dex, peg-asp | 1647 | 7 | None | Thrombosis: DVT (86 days post) | O-3 FA (7) | Yes | |
| 11 | 1st | Re-induction I Day 13 | Dex, peg-asp | 2399 | 7 | Abdominal pain, fever | HBS | O-3 FA (14) | Only 1 dose (discontinued for hyperbilirubinemia) | |
| 12 | 1st 2nd |
Re-induction I Day 1 Re-induction II Day 1 |
Dex, peg-asp Dex, peg-asp |
3059 3578 |
NA NA |
None None |
HBS | O-3 FA (120) O-3 FA (continue) |
Yes | |
| 13 | 1st | Re-induction I Day 1 | Dex, peg-asp | 1721 | NA | None | – | Yes | ||
| 14 | 1st 2nd 3rd |
Re-induction I week 1 Continuation Week 22 Continuation Week 32 |
Dex, peg-asp Dex, peg-asp Dex, peg-asp |
5489 2036 1790 |
17 25 7 |
None Fever Nausea, emesis |
Hyponatremia, HBS Hyponatremia, HBS HBS |
Thrombosis: DVT, PE (2 days pre) | O-3 FA (77), Fibrate (74) O-3 FA (153), Fibrate (153) O-3 FA, Fibrate (continue) |
Yes Yes (held 1 dose) No (none due) |
| 15 | 1st | Re-induction II Day 1 | Dex, peg-asp | 2066 | NA | None | Thrombosis: DVT, PE (69 days pre) | – | Yes (held 1 dose) | |
| 16 | 1st 2nd 3rd 4th |
Re-induction I Day 8 Continuation, Week 15 Re-induction II Day 14 Continuation Week 30 |
Dex, peg-asp Dex, peg-asp Dex, peg-asp Dex, peg-asp |
1801 1169 1216 2606 |
42 7 5 7 |
None None None Fatigue, diarrhea, back pain |
Transaminitis, hyponatremia HBS Transaminitis, HBS Transaminitis, hyponatremia, HBS |
O-3 FA (180), Fibrate (90) O-3 FA, Fibrate (continue) O-3 FA, Fibrate (continue) O-3 FA (continue), Fibrate (35) |
Yes Yes Yes No (none due) |
|
| 17* | 1st | Re-induction II Day 1 | Dex, peg-asp | 1982 | 14 | None | Transaminitis, HBS | O-3 FA (365), Fibrate (71) | Yes | |
| 18* | 1st | Re-induction II Day 1 | Dex, peg-asp | 1660 | NA | None | Thrombosis: cortical vein (70 days pre) | – | Yes |
TGL: triglyceride; Pred: prednisone; Dex: dexamethasone; Asp: asparaginase; NA: not available; PE: pulmonary embolism; DVT: deep venous thrombosis; O-3FA: omega-3 fatty acids; HBS: hemolyzed blood sample
*
Patients who developed symptomatic osteonecrosis during therapy