FREQUENCY OF DRUG INDUCED HYPERGLYCEMIA DURING REMISSION INDUCTION THERAPY IN ADULTS WITH ACUTE LYMPHOBLASTIC LEUKEMIA

Drug Induced Hyperglycemia

Abstract

Objectives: To determine the frequency of drug induced hyperglycemia during remission induction and its
associated risk factors in adult acute lymphoblastic leukemia (ALL) patients.
Study Design: Cross sectional study.
Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from May 2017 to Nov 2017.
Material and Methods: Fifty one adult patients of newly diagnosed ALL were enrolled in the study. Inclusion
criteria included, eighteen years or older, treatment naïve. Patients with history of diabetes, on-going treatment or
were taking drugs causing hyperglycemia were excluded from the study. Possible risk factors were recorded
including age, body mass index (BMI), gender, family history of diabetes, history of hypertension and disease
risk stratification for ALL. Patients were started on standard or augmented Berlin-Frankfurt-Münster (BFM)
protocol according to risk category. Fasting and random glucose levels were done twice a week during induction
chemotherapy. Hyperglycemia was diagnosed when patients experienced blood glucose greater than 126 mg/dL
as fasting or greater than 200mg/dL as post prandial. Data were analyzed using SPSS version 23.
Results: Eighteen of our fifty one enrolled patients (35.3%) experienced hyperglycemia during induction
chemotherapy. There was also significant increase in fasting blood sugar levels from baseline readings after
induction chemotherapy (p-value<0.001). Univariate analysis demonstrated significant association between
fasting high blood sugar after induction chemotherapy with age (p-value <0.001) and BMI (p-value=0.034). While
on multivariate analysis only age (p<0.001) was found to have significant association with hyperglycemia.
Conclusion: Hyperglycemia was observed in less than half of our adult ALL patients during induction chemotherapy.
Age was a significant risk factor associated with hyperglycemia.