Asparaginase and Steroids-induced Extreme Hypertriglyceridemia in a Child with Acute Lymphoblastic Leukemia

Asparaginase has been used in the treatment of childhood acute lymphoblastic leukemia (ALL) for more than 30 years. It is combined with steroids in most pediatric ALL treatment protocols and hyperlipidemia is a common side effect. However, severe hyperlipidemia is rare. Risk of major clinical complications increases significantly when serum triglyceride level is greater than 1,000 mg/ dl. Here, we report a child with ALL who developed extreme hypertriglyceridemia without clinical symptoms during reinduction of maintenance therapy. Following administration of oral gemfibrozil, her triglyceride and cholesterol levels gradually fell to within normal range. Further treatment of ALL was not altered and her hyperlipidemia resolved without sequelae.