Prevalence and Risk Factors of Acute Pancreatitis in Childhood Acute Leukemia

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Abstract
Background/Objectives: Acute pancreatitis (AP) is an uncommon but serious complication in children undergoing treatment for acute leukemia. We aimed to determine the prevalence of AP in pediatric patients with acute leukemia, identify its risk factors, and evaluate their impact on treatment outcomes and overall survival. Materials and Methods: We retrospectively reviewed the medical records of children with acute leukemia who developed acute abdominal pain suggestive of AP at Songklanagarind Hospital between 2004 and 2024. Demographic data, including leukemia subtypes, treatment protocols, and clinical outcomes, were compared between the patients with and without AP. Results: Of the 618 patients with leukemia, 70 children with abdominal pain were identified, and 17 were diagnosed with AP. The prevalence of AP was 2.8%. Most children with acute leukemia and AP had T-cell subtypes (50.0%) and received high- to very-high-risk treatment protocols (76.5%). Patients with AP experienced a shorter duration of abdominal pain before diagnosis and required imaging more frequently than the non-AP patients did (100% vs. 56.6%). They required a prolonged fasting period and greater intravenous fluid volume within 48 h. The overall mortality rate (all-cause during follow-up) was significantly higher in the AP group. Using high- to very-high-risk chemotherapy protocols was a risk factor for AP, and the accumulative L-asparaginase dose of ≥55,200 IU/m2 could increase AP risk. Conclusions: AP is significantly associated with increased overall mortality in children with acute leukemia. Careful monitoring of L-asparaginase dosing may be required. Larger studies are needed to better identify the risk factors and preventive strategies.

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