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

BACKGROUND: Hyperglycaemia is a common side effect of steroid and L-asparaginase combinations, occurring most often during acute lymphoblastic leukemia (ALL) induction phase. To date in Indonesia, it has not been obtained data on the incidence of hyperglycemia in children with ALL in the induction phase and how the role of combinations of L-asparaginase and different type of steroid used. The purpose of this study is to determine the incidence of hyperglycemia in children ALL induction phase, knowing the difference between prednisone and dexamethasone (in combination with L-asparaginase) in causing hyperglycemia in children with ALL and determine the relationship of other factors related to hyperglycaemia. METHODS: This was a prospective analytic study with a pre- and post-test design, conducted in three hospitals (Cipto Mangunkusumo Hospital, Dharmais Cancer Hospital, and Gatot Soebroto Hospital). Patient’s blood glucose levels (BGL) were checked at the 3(rd) (pretest), 4(th), 5(th) and 6(th) week of protocol (post-test). RESULT: Of the 57 patients, 5.2% had hyperglycemia. The patients’ age ranged from 1.4 years old to 15.8 years old (6.7 years old). There was no relationship between age, central nervous system (CNS) infiltration, leukocytosis, Down syndrome, nutritional status, family history of diabetes, infections and ALL stratification with hyperglycemia (p>0.05). Dexamethasone has more chance of obtaining higher mean rate of change in BGL compared to prednisone. (p < 0.05; RR 10.68; CI 95% 1.52-74.73). CONCLUSION: The incidence of hyperglycemia in this study is 5.2%. Dexamethasone, in combination with L-asparaginase, despite having no difference in causing hyperglycemia, has an increased risk of changing BGL compared to prednisone.