BLOOD LIPID PROFILES IN CHILDREN WITH ACUTE LYMPHOBLASTIC-LEUKEMIA

BACKGROUND. Abnormal blood lipid profiles have been associated with ca ncer. The objective of this study was to investigate the frequency and clinical significance of altered lipid profiles in children with acut e lymphoblastic leukemia (ALL), the most common form of malignant dise ase in this age group. METHODS. Fasting blood lipid profiles (choleste rol [C], triglycerides [TG], high density lipoprotein [HDL], low densi ty lipoprotein, very low density lipoprotein, apolipoproteins A(1) [ap o A(1)] and B, and lipoprotein a [Lp(a)]) were obtained in 24 children with ALL at diagnosis, 16 children during consolidation therapy with L-asparaginase, and 18 children during maintenance therapy without L-a sparaginase. For comparison the authors studied lipid profiles in 15 c hildren previously treated for leukemia, 15 healthy control children, and 17 children with other forms of cancer, both localized and widespr ead. RESULTS. An altered blood lipid profile was observed at the time of diagnosis of ALL. Statistically significant values included elevate d TG (1.82 +/- 1.23 mmol/L), reduced HDL-C (0.54 +/- 0.24 mmol/L), and reduced ApoA, (0.77 +/- 0.18 g/L) levels. A wide range of Lp(a) level s (0-1990 mg/L) were observed. Significantly reduced HDL-C (0.55 +/- 0 .20 mmol/L) and ApoA, (0.69 +/- 0.22 g/L) were observed in children wi th widespread but not localized solid tumors at diagnosis. C and TG co rrelated with serum albumin levels. Significant therapy-related change s in lipid profiles were observed in children with ALL during combinat ion therapy with L-asparaginase (extremely elevated TG levels [3.34 +/ - 2.82 mmol/L] and a striking reduction in Lp(a) levels) that were not observed during combination therapy without L-asparaginase or in chil dren during treatment for solid tumors. In this small study there was no relation between these abnormalities and either thromboembolic even ts or pancreatitis. Blood lipid profiles in children with ALL returned to normal on completion of therapy. CONCLUSIONS, The lipid abnormalit ies observed at diagnosis in children with widespread cancer (ALL or s olid tumors) may reflect altered nutritional states or altered lipid m etabolism. Reduced concentrations of Lp(a) and elevated TG levels sugg est L-asparaginase specific alterations and may provide insight into t he toxicity associated with this drug. (C) 1998 American Cancer Societ y.