ARS | Publication request: Hyperglycemia during induction therapy is associated with increased infectious complications in childhood acute lymphocytic leukemia

Submitted to: Pediatric Blood and Cancer
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: April 14, 2008
Publication Date: November 15, 2008
Citation: Sonabend, R.Y., McKay, S.V., Okcu, M.F., Yan, J., Haymond, M.W., Margolin, J.F. 2008. Hyperglycemia during induction therapy is associated with increased infectious complications in childhood acute lymphocytic leukemia. Pediatric Blood and Cancer. 51(3):387-392

Interpretive Summary: Children with Acute Lymphocytic Leukemia, the most common type of childhood cancer, are at risk for developing high blood sugars because of the medicines they receive, known as chemotherapy. We predicted that children who develop high blood sugars will be at greater risk for developing infections during the first year of treatment for leukemia. We reviewed the records of 135 patients who were diagnosed between 1999 and 2001 at Texas Children's Hospital and found that 56% of all the children developed high blood sugars. Older children and obese children were most likely to exhibit high blood sugars. Patients with very high sugar levels were four times as likely to have serious infections in the blood and skin. Additionally, these children were four times as likely to be admitted for overnight hospitalization because of fever and low white blood cell counts. We therefore conclude that children with leukemia have a high likelihood of developing high blood sugars which puts them at risk for future infections.

Technical Abstract: Children with acute lymphocytic leukemia (ALL) are at high risk for developing hyperglycemia. Hyperglycemic adult ALL patients have shorter remissions, more infections, and increased mortality. No corresponding data are available in children. We hypothesized that children with ALL who become hyperglycemic during induction chemotherapy have an increased risk for infection during their first year of treatment. We conducted a retrospective chart review of 135 patients diagnosed with ALL during 1999-2001 at Texas Children's Hospital. Infectious outcomes during the first year of therapy were compared in three groups patients based on blood glucose concentrations during induction therapy: euglycemic (<140 mg/dl), mild hyperglycemic (MH) (140-199 mg/dl), and overt hyperglycemic (OH) (blood glucose >200 mg/dl). Seventy-five (56%) patients met criteria for either MH (21%) or OH (35%). Hyperglycemia was more prevalent in older children (P < 0.001) and those at risk for being overweight (BMI% >85%) at diagnosis (P < 0.01). Patients with MH and OH were 2.5 times (95% CI 1.0-6.2) and 2.1 times (95% CI 1.0-4.6) more likely to have documented infections, respectively. Patients with OH were 4.2 times (95% CI 1.5-12) more likely to have bacteremia/fungemia, 3.8 times (95% CI 1.2-11.6) more likely to have cellulitis, and 4.0 times (95% CI 1.7-9.3) more likely to be admitted for fever and neutropenia than the euglycemia group. Hyperglycemia, especially when overt, may be a previously unrecognized risk factor of infectious complications in children with ALL during the first year of treatment.