Transient diabetes mellitus secondary to l-asparaginase and dexamethasone during induction phase of acute lymphoblastic leukaemia therapy

ABSTRACT Diabetes mellitus (DM) is an unusual event following chemotherapy for acute lymphoblastic leukemia (ALL) and occurs in approximately 10 to 15% of pediatric patients with ALL. It has been attributed to the use of l-asparaginase, glucocorticoids, and to infection. Recent study revealed that children with ALL, who experienced hyperglycemia during induction therapy, demonstrates poorer relapse-free survival (RFS) and overall survival (OS) rates. Patients with hyperglycemia during treatment should be screened for clinical evidence of diabetes mellitus (DM), which may require more intensive supportive care than those without DM. Although DM is rare during treatment of ALL, it carries signi?cant morbidity and mortality. We describe a case of 13 years old Indonesian girl who was diagnosed with High risk ALL in January 2015. As part of the induction phase, she was treated with l-asparaginase 7500 u/m2 for 3 weeks and oral dexamethasone 6 mg/m2 for 6 weeks. Two weeks after l-asparaginase and four weeks of dexamethasone therapy, she had DM with blood serum glucose of 522 mg/dL, HbA1c was increased to 9.68% and C-peptide was 0.6 ng/ mL. She was successfully treated with insulin therapy. Over the next 3 months, the blood glucose level was stable between 57 to 115 mg/ dL. HbA1c was 5.1% and C-peptide was 3.20 ng/mL. Then, she was diagnosed with transient diabetes mellitus (DM). Key words: Acute lymphoblastic leukemia, diabetes mellitus, l-asparaginase, dexamethasone