Asparaginase, an agent used in the treatment of acute lymphoblastic leukemia (ALL), is associated with the development of pancreatitis. The clinical course and long‐term outcome of patients experiencing this complication has not been extensively detailed.

We reviewed the clinical course for all children with ALL diagnosed with pancreatitis at the Dana‐Farber Cancer Institute/Children's Hospital Boston between 1987 and 2003. The outcome of these patients was compared with that of patients with ALL who did not experience pancreatitis.

Twenty‐eight of 403 children (7%) were diagnosed with pancreatitis. Patients 10–18 years old at diagnosis had 2.4 times the risk of developing pancreatitis compared with younger patients. Pancreatitis typically occurred early in the course of therapy (median 4 weeks after first dose of asparaginase). Ninety‐three percent of affected patients were hospitalized and 57% received parenteral nutrition. No patient developed chronic sequelae or died as a result of pancreatitis. Sixteen (57%) patients were re‐treated with asparaginase, 10 of whom had another episode of pancreatitis. No significant differences in event‐free survival were observed when comparing patients with and without a history of pancreatitis.

Asparaginase‐associated pancreatitis was more common in older children, and caused significant acute morbidity. It tended to occur after the first few doses of asparaginase, suggesting a predisposition to this complication rather than a cumulative drug effect. Re‐treatment with asparaginase after an episode of pancreatitis was associated with a high risk of recurrent pancreatitis. Pediatr Blood Cancer 2009;53:162–167. © 2009 Wiley‐Liss, Inc.