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Acute central nervous system complications and ammonium levels in adult patients with acute lymphoblastic leukemia receiving l-asparaginase


Strickler, Nicole; Balabanov, Stefan; Casauro, Katharina; Schanz, Urs; Manz, Markus G; Gerber, Bernhard (2018). Acute central nervous system complications and ammonium levels in adult patients with acute lymphoblastic leukemia receiving l-asparaginase. Leukemia & Lymphoma, 59(4):855-862.

Abstract

We analyzed ammonium levels and acute central nervous complications in adult patients receiving chemotherapy for acute lymphoblastic leukemia with or without asparaginase (l-asp). Twenty patients with a median age of 40.3 years were included. Ammonium-levels were measured during 88 chemotherapy cycles, 60 cycles (68%) with l-asp, and 28 cycles (32%) without l-asp. Ammonium was elevated in 87% of all l-asp containing cycles, with median ammonium levels of 169 μmol/l (interquartile range (IQR) 91-269 μmol/l). These values were higher when compared to ammonium levels at baseline (31.5 μmol/l, IQR 24-40 μmol/l, p < .001), and when compared to levels in cycles without l-asp (30 μmol/l, IQR 19-41 μmol/l, p < .001). Acute hyperammonemic encephalopathy was diagnosed in one patient, and encephalopathy for other reasons, but with hyperammonemia as a possible contributing factor in four patients. In conclusion, ammonium levels are elevated in all adult patients receiving l-asparaginase, but only some patients will present symptoms of encephalopathy.

Abstract

We analyzed ammonium levels and acute central nervous complications in adult patients receiving chemotherapy for acute lymphoblastic leukemia with or without asparaginase (l-asp). Twenty patients with a median age of 40.3 years were included. Ammonium-levels were measured during 88 chemotherapy cycles, 60 cycles (68%) with l-asp, and 28 cycles (32%) without l-asp. Ammonium was elevated in 87% of all l-asp containing cycles, with median ammonium levels of 169 μmol/l (interquartile range (IQR) 91-269 μmol/l). These values were higher when compared to ammonium levels at baseline (31.5 μmol/l, IQR 24-40 μmol/l, p < .001), and when compared to levels in cycles without l-asp (30 μmol/l, IQR 19-41 μmol/l, p < .001). Acute hyperammonemic encephalopathy was diagnosed in one patient, and encephalopathy for other reasons, but with hyperammonemia as a possible contributing factor in four patients. In conclusion, ammonium levels are elevated in all adult patients receiving l-asparaginase, but only some patients will present symptoms of encephalopathy.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Hematology
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:Asparaginase, acute lymphoblastic leukemia, adult, ammonium, encephalopathy
Language:English
Date:2018
Deposited On:30 Oct 2017 15:23
Last Modified:27 Feb 2018 02:01
Publisher:Informa Healthcare
ISSN:1026-8022
OA Status:Closed
Publisher DOI:https://doi.org/10.1080/10428194.2017.1352090
PubMed ID:28728499

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