Acarbose is an effective treatment for severe hypertriglyceridemia secondary to l-asparaginase and dexamethasone

摘要

L-asparaginase is a drug used in the treatment of childhood acute lymphoblastic leukemia (ALL). Its action is the hydrolysis of L-asparagine, which depletes the supply of this amino acid needed for protein synthesis and cell functioning, in cancer cells. It is documented to cause lipid abnormalities, especially hypertriglyceridemia, in as many as 67-72% [1,2] of treated patients. In a retrospective analysis [2] of 65 children and adolescents with ALL treated with L-asparaginase, it was noted that five (12%) patients developed severe hypertriglyceridemia (triglyceride level more than 1000 mg/dL or more than 11.4 mmol/L). The postulated mechanism is the inhibition of lipoprotein lipase (LPL) [3,4], which is a vital enzyme in the removal of triglyceride (TG) from the TG-rich lipoproteins, which results in high levels of exogenous chylomicron bound triglycerides found during the period of L-asparaginase treatment [5]. Corticosteroids, especially dex-amethasone, are also an integral component of chemotherapy, which exacerbates the severity of hypertriglyceridemia with increased endogenous production of very-low-density lipoprotein (VLDL) [6,7].