TRANSIENT HYPERLIPIDEMIA DURING TREATMENT OF ALL WITH L-ASPARAGINASE IS RELATED TO DECREASED LIPOPROTEIN-LIPASE ACTIVITY

A 13-year-old girl with acute lymphoblastic leukemia (ALL) developed e xtremely high plasma triglyceride (TG) concentrations of 103 mmol/l (r eference value <1.8 mmol/l) during combination treatment with corticos teroids and asparaginase. Corticosteroids are known to induce the prod uction of TO-rich particles. On the other hand, corticosteroids increa se the activity of lipoprotein lipase (LPL), a key enzyme in the remov al of TG from plasma. Generally, the increased LPL activity prevents a n extreme rise in TG levels upon therapy with corticosteroids. In our patient, we found that the corticosteroid-induced LPL activity dramati cally declined after therapy with L-asparaginase. This suggests that t he extensive hypertriglyceridemia in our patient was due to an L-aspar aginase-induced decrease in LPL activity. This hypothesis was further supported by the finding that hypertriglyceridemia was less severe whe n corticosteroids and asparaginase were given separately.