Hyperammonemia in children treated with asparaginase for acute lymphoblastic leukaemia

Background: Asparaginase is a key component of pediatric acute lymphoblastic leukemia (ALL) chemotherapy. Hyperammonemia is a known side effect of this treatment, but its clinical implications in this population are poorly understood.

Methods and results: We described 25 children (median age of 7 years) with hyperammonemia under asparaginase treatment for ALL between January 2016 and April 2022 in the seven centers of the "Grand Ouest Cancers de l’Enfant" (GOCE) group. Among these patients, 13 (52%) were symptomatic, including neurological symptoms in 9 patients and isolated vomiting in 4 patients. Three patients required therapeutic intervention.

Conclusion: The results showed a dissociation between ammonia levels and the severity of clinical manifestations of hyperammonemia. Further studies are needed to better understand the observed clinical inter-individual variability within the same range of ammonia levels.