Clinical Advances in Hematology & Oncology Volume 7, Issue 7 July 2009 465 Transient Hyperglycemia During Childhood Acute Lymphocytic Leukemia Chemotherapy: An Old Event Revisited Angela Maria Spinola-Castro, MD, PhD, Adriana Aparecida Siviero-Miachon, MD, Solange Andreoni, PhD, Patricia Debora Cavalcanti Tosta-Hernandez, MD, Carla Renata Pacheco Donato Macedo, MD, and Maria Lucia de Martino Lee, MD Dr. Spinola-Castro is a Professor in the Division of Pediatric Endocrinology, Department of Pediatrics, where Dr. Siviero-Miachon is Assistant Attending Physician. Dr. Andreoni is a Professor in the Division of Biostatistics, Department of Preventive Medicine. Dr. Tosta-Hernandez is Assistant Attending Physician in the Division of Pediatric Endocrinology, Department of Pediatrics. Dr. Macedo is Assistant Attending Physician in the Pediatric Oncology Institute, and Dr. Lee is a Pediatric Hematologist in the Pediatric Oncology Institute in Federal University of Sao Paulo, Sao Paulo, Brazil. Abstract: Hyperglycemia has been described as a common event occurring during acute lymphocytic leukemia chemotherapy. It is associated with the synergistic effect of L-asparaginase and gluco- corticoids, and related to poor outcome. Our goal was to compare clinical and laboratory findings between hyperglycemic episodes occurring during childhood acute lymphocytic leukemia induction chemotherapy. Here we describe 12 (3.8%) high-risk patients of 311 total patients, 9 (75%) of who are female. The 12 patients presented with 16 hyperglycemic episodes classified into adverse or satisfac- tory categories. There were no differences in clinical or laboratory variables among groups, although the majority of episodes occurred in pubescents, regardless of the type of glucocorticoid employed. Despite the fact that only 1 patient was overweight, pancreatitis was not diagnosed. Although we could not determine whether hypergly- cemia predicts an adverse outcome, glucose evaluation played an important role during induction chemotherapy. To date, recognized risk factors for hyperglycemia no longer explain our findings, thus other mechanisms related to insulin secretion and action should be further studied. Introduction e tremendous improvement in survival of children diagnosed with cancer has resulted in a growing population that experiences at least one late effect. Long-term complications in childhood cancer survivors, such as growth impairment or endocrine dysfunc- tion, are well known and not only related to the specific therapy used—chemotherapy and radiotherapy—but also determined by individual host characteristics. 1 Nonetheless, short-term adverse effects of cancer treatment protocols should call our attention to their potential influence on morbidity. Hyperglycemic hyperosmolar nonketotic syndrome and diabetic ketoacidosis—life-threatening acute complications—have Keywords Hyperglycemia, insulin, leukemia, lymphocytic, acute/drug therapy, asparaginase, glucocorticoid Address correspondence to: Angela Maria Spinola-Castro, MD, PhD Division of Pediatric Endocrinology, Department of Pediatrics Federal University of Sao Paulo- UNIFESP/EPM, Brazil 307 Doutor Diogo de Faria Street Sao Paulo, Brazil 04037-000 Phone: + 55 11 5539-1093 Fax: + 55 11 5579-9409 E-mail: aspinola.dped@epm.br