A 6-year-old boy on induction chemotherapy for acute lymphoblastic leukaemia develops severe mid-abdominal pain radiating to the back with vomiting. Serum amylase is markedly elevated. Which drug in his regimen is the most likely cause?
- A L-asparaginase ✓
- B Vincristine
- C Prednisolone
- D Methotrexate
Correct answer: A. L-asparaginase
Explanation
L-asparaginase, a cornerstone of ALL induction, characteristically causes pancreatitis through depletion of circulating asparagine affecting acinar cells, along with hypersensitivity reactions, coagulopathy from reduced hepatic synthesis of clotting factors, and hyperglycaemia. Vincristine causes neuropathy, prednisolone causes hyperglycaemia and myopathy, and methotrexate causes mucositis and hepatotoxicity, none of which present as acute pancreatitis.
Reference: Nelson Textbook of Pediatrics, 22nd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.