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TRANSIENT HYPERGLYCEMIA DURING ACUTE LYMPHOBLASTIC LEUKEMIA THERAPY: REVISITING RISK FACTORS AMONG INTERNATIONAL PROTOCOLS
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  • Lívia Cristina Oliveira e Silva,
  • Adriana Aparecida Siviero-Miachon,
  • Ana Virgínia Lopes Sousa,
  • Angela Maria Spinola e Castro
Lívia Cristina Oliveira e Silva
Universidade Federal de Sao Paulo - Campus Sao Paulo
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Adriana Aparecida Siviero-Miachon
Universidade Federal de Sao Paulo - Campus Sao Paulo

Corresponding Author:[email protected]

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Ana Virgínia Lopes Sousa
Hospital of the Support Group for Adolescent and Children with Cancer - GRAACC
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Angela Maria Spinola e Castro
Universidade Federal de Sao Paulo - Campus Sao Paulo
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Abstract

Background/Objectives: Transient hyperglycemia is an early endocrine effect observed during ALL chemotherapy. The goal of this study was to identify risk factors to hyperglycemia, compare data from two international protocols, and perceive if its occurrence leads to worse outcomes, such as infection, ALL relapse, or death. Methods: Data refers to a cohort of 188 pediatric patients undergoing ALL treatment at GRAACC/UNIFESP between 2004 and 2017. The effect of individual characteristics (protocol treatment, gender, age, ethnicity, family history of diabetes, puberty, nutritional status, ALL cell lineage, and chromosome Philadelphia) on hyperglycemia development was analyzed by univariate and multivariate logistic regression models. The role of hyperglycemia as a risk factor for infection, ALL relapse, and death was analyzed by ordinal logit regression, Fine and Gray competing risks models, and univariate and multivariate Cox regression, respectively. Results: The incidence of hyperglycemia was 43,6%. Puberty led to 7.9 greater risk for hyperglycemia (p=0.017). An increase of one year of age led to a 14% reduction in the chance of hyperglycemia among prepubertal individuals (p=0.039). The intermediate risk for ALL relapse had 67% less chance for hyperglycemia than high-risk patients (p=0.020). Hyperglycemia was not a risk factor for infection during ALL treatment (p=0.840), for ALL relapse (p=0.302), or for death (p=0.134). Conclusions: The identified risk factors for hyperglycemia during ALL chemotherapy were: younger age, puberty, and intermediate risk for ALL relapse. There was no difference in hyperglycemia incidence between patients undergoing GBTLI-2009 or BFM protocols. Hyperglycemia did not lead to worse outcome.