# Prevalence and Risk Factors of Acute Pancreatitis in Childhood Acute Leukemia

## TL;DR

This study finds that acute pancreatitis occurs in 2.8% of children with acute leukemia and is linked to higher mortality and specific treatment factors.

## Contribution

The study identifies T-cell leukemia subtype and high-dose L-asparaginase chemotherapy as risk factors for acute pancreatitis in pediatric leukemia patients.

## Key findings

- Acute pancreatitis occurred in 2.8% of 618 leukemia patients.
- Higher mortality and treatment complications were observed in patients with AP.
- High L-asparaginase doses and T-cell leukemia were significant risk factors.

## Abstract

Acute pancreatitis (AP) is a rare but serious complication in children receiving treatment for acute leukemia. We retrospectively reviewed cases from 2004 to 2024 at Songklanagarind Hospital to determine prevalence, risk factors, and outcomes. Among 618 patients, 17 (2.8%) were diagnosed with AP, which was more common in patients with T-cell leukemia and in those receiving high- to very-high-risk chemotherapy. Compared with patients without AP, those with AP required more imaging studies, prolonged fasting, and greater intravenous fluid support. Overall mortality was significantly higher in the AP group. An increased AP risk was associated with the use of high- to very-high-risk treatment protocols and a cumulative L-asparaginase dose ≥55,200 IU/m2. Three patients received L-asparaginase after AP resolved; all were high- to very-high-risk cases, and one developed persistent AP with walled-off necrosis. This finding may indicate genetic susceptibility, although genetic testing was not performed. Careful monitoring of L-asparaginase dosing is recommended.

Background/Objectives: Acute pancreatitis (AP) is an uncommon but serious complication in children undergoing treatment for acute leukemia. We aimed to determine the prevalence of AP in pediatric patients with acute leukemia, identify its risk factors, and evaluate their impact on treatment outcomes and overall survival. Materials and Methods: We retrospectively reviewed the medical records of children with acute leukemia who developed acute abdominal pain suggestive of AP at Songklanagarind Hospital between 2004 and 2024. Demographic data, including leukemia subtypes, treatment protocols, and clinical outcomes, were compared between the patients with and without AP. Results: Of the 618 patients with leukemia, 70 children with abdominal pain were identified, and 17 were diagnosed with AP. The prevalence of AP was 2.8%. Most children with acute leukemia and AP had T-cell subtypes (50.0%) and received high- to very-high-risk treatment protocols (76.5%). Patients with AP experienced a shorter duration of abdominal pain before diagnosis and required imaging more frequently than the non-AP patients did (100% vs. 56.6%). They required a prolonged fasting period and greater intravenous fluid volume within 48 h. The overall mortality rate (all-cause during follow-up) was significantly higher in the AP group. Using high- to very-high-risk chemotherapy protocols was a risk factor for AP, and the accumulative L-asparaginase dose of ≥55,200 IU/m2 could increase AP risk. Conclusions: AP is significantly associated with increased overall mortality in children with acute leukemia. Careful monitoring of L-asparaginase dosing may be required. Larger studies are needed to better identify the risk factors and preventive strategies.