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Q: ASAP cancer related question ( Answered,   4 Comments )
Subject: ASAP cancer related question
Category: Health > Conditions and Diseases
Asked by: confusionamidchaos-ga
List Price: $50.00
Posted: 31 Oct 2006 09:02 PST
Expires: 30 Nov 2006 09:02 PST
Question ID: 778792
A friend of mine has had acute lymphocytic cancer and is in remission.
He is undergoing chemeotherapy but recently having problems with his
pancreas.  Any information about this relationship would be
appreciate. If there are any physicians doing research into this
specific problems, their names would be appreciated.

Request for Question Clarification by crabcakes-ga on 31 Oct 2006 09:50 PST

  What kind of problems is he having with his pancreas? Does he now
have cancer of the pancreas? Or is he having insulin/glucose problems?
How old is your friend? Do you know what type of chemo he has

Where does your friend live? (Ciy and state only, please) Is he
willing to travel to see a specialist?

Any additional information will be useful in providing you with an
accurate answer.

   Regards, Crabcakes

Clarification of Question by confusionamidchaos-ga on 31 Oct 2006 11:28 PST
My friend has ALL (Acute Lymphocytic Leukemia).  He is 25 years old. 
He has had many tests for Gallstones, but all have come back negative.
 I do not believe he has had any glucose/insulin problems, merely, his
pancreas is severely inflamed.  He has been administered a number of
chemo meds; vincristine, methatrexate, and more that i cannot recall
off the top of my head.
I do not believe he is in a position to travel, considering how
nutropenic he is.  But he is receiving treatment at the Huntsman Caner
treatment center in Salt Lake City, Utah.  They all seem to be stumped
as to what is causing this inflammation and severe pain.  The fear is
that the chemo irritated his pancreas into a kind of "eating itself"
phase...which I believe is deadly and irreversible.  Otherwise, we may
be dealing with an infection, which is also not good for someone who's
immune system is so compromised.
Any help you could offer would be greatly appreciated.

Request for Question Clarification by crabcakes-ga on 31 Oct 2006 12:23 PST
Thank you for the additional information. I'll be working on it today!

Sincerely, Crabcakes

Clarification of Question by confusionamidchaos-ga on 31 Oct 2006 17:07 PST
I might need to go visit him tonight. The sooner I can get an answer
the better. Thanks!
Subject: Re: ASAP cancer related question
Answered By: crabcakes-ga on 31 Oct 2006 20:39 PST
Hello Confusionamidchaos,

   There are several known causes of pancreatitis, but often too, the
cause is unknown. Gallstones are one common reason, as is alcoholism,
heredity, excess blood lipids, and certain drugs, elevated blood
calcium, and more. You?ve stated that gallstones are already ruled
out. The only connections I found to pancreatitis and ALL is the
chemotherapy and other treatments that can trigger pancreatitis in a
small number of people. I?ve outlined them below:


Pancreatitis is a known side effect of methotrexate.

   See page three, where it states that methotrexate can cause
pancreatitis early on the treatment.

  ?Other adverse reactions that have been reported with methotrexate
are listed below by organ system. In the oncology setting, concomitant
treatment and the underlying disease make specific attribution of a
reaction to methotrexate difficult.

Alimentary System: gingivitis, pharyngitis, stomatitis, anorexia,
nausea, vomiting, diarrhea, hematemesis, melena, gastrointestinal
ulceration and bleeding, enteritis, pancreatitis.?

  ?Concomitant administration of some NSAIDs with high dose
methotrexate therapy has been reported to elevate and prolong serum
methotrexate levels, resulting in deaths from severe hematologic and
gastrointestinal toxicity.
Caution should be used when NSAIDs and salicylates are administered
concomitantly with lower doses of methotrexate. These drugs have been
reported to reduce the tubular secretion of methotrexate in an animal
model and may enhance its toxicity.? NSAIDS include Advil (Ibuprofen),
Naprosyn, Mobic, etc.  

Oncaspar (pegaspargase)

   Is it possible your friend was given Oncaspar (pegaspargase)? This
is at times given after vincristine for ALL, and is known for causing
pancreatitis (Inflammation of the pancreas).

   ?Pegaspargase has been formulated to remain active in the body for
a longer period of time than asparaginase. Pegaspargase produces its
anti-cancer effects in the same manner as asparaginase, by ?breaking
down? asparagine, a substance normally found in the body that is
involved in biological processes that are essential for cells to live.
 Healthy cells are able to create asparagine for themselves; however,
leukemic cancer cells are not able to create asparagine for
themselves. Therefore, the depletion of asparagine by pegasparagase
deprives tumor cells of the amino acid needed for protein synthesis,
thereby killing cancer cells. Because healthy cells make asparagine
for themselves, they do not tend to be as affected by pegasparagase.?

?Inflammation of the pancreas (pancreatitis) is a side effect of
treatment with pegaspargase. Patients experiencing severe abdominal
pain should contact their healthcare provider.?

   ?Oncaspar is the trade name for pegaspargase. PEG-L-asparaginase is
another name for pegaspargase. In some cases, health care
professionals may use the trade name oscaspar or other names
PEG-L-asparaginase when referring to the generic drug name

Drug type: Pegaspargase is an anti-cancer ("antineoplastic" or
"cytotoxic") chemotherapy drug.  This medication is classified as an
?A serious but rare side effect of pegaspargase is pancreatitis
(inflammation of the pancreas).

?Symptoms of acute pancreatitis include: (pain in the upper abdomen
that worsens with eating, swollen and tender abdomen, nausea,
vomiting, fever, and rapid pulse).

   ?Pegaspargase is mainly given in combination with other drugs
vincristine (a vinca alkaloid anticancer drug) and steroids (either
prednisone or dexamethasone). Other chemotherapy medicines are added
to this regimen if a patient is at a high risk for disease

   ?ALL patients who received native E. coli L-asparaginase during the
same time period developed pancreatitis (P= 0.007). Conclusion.
Clinicians should be aware of a possible higher incidence of
pancreatitis associated with pegaspargase.?

   ?Mercaptopurine is used as part of the consolidation and
maintenance treatment for acute lymphocytic leukemia (ALL) and acute
myelocytic leukemia (AML).?

? The use of 6-MP in pregnant women should be avoided whenever
possible, especially during the first three months of pregnancy, as
6-MP can cause birth defects and spontaneous abortions.
As 6-MP can lower the body's ability to fight infections, patients are
advised to avoid contact with people who have a cold, flu, or other
Mercaptopurine should be used with caution in the following populations:
?people who had an allergic reaction to 6-MP in the past 
?people at risk for pancreatitis (inflammation of the pancreas?

      ?The buffered formulations of didanosine can decrease absorption
of various drugs, including ketoconazole, dapsone, tetracyclines, and
certain quinolones Ranitidine increases didanosine bioavilability
modestly. 276 The risk of pancreatitis is increased by exposure to
intravenous pentamidine and probably other agents (Table 7). Agents
associated with peripheral neuropathy should be used cautiously in
association with didanosine?

   Does your friend take or has he taken any of the following drugs?
Zyprexa, Risperdal, Seroquel or Geodon ? They can cause pancreatitis.
Prednisone can also cause pancreatitis.

   ?A number of agents used in cancer chemotherapy are extremely
irritating if they extravasate or infiltrate into the tissues rather
than remaining within the vasculature. Chemotherapy agents can be
divided into the following categories:  See chart of regimens that can
irritate organs and tissue.

This article pertains to AML, but your friend may have taken some of the same drugs
?All-trans-retinoic acid (ATRA) has been successfully used in the
treatment of acute promyelocytic leukemia (APL). One of its adverse
effects is acute pancreatitis. In the literature, a proposed cause of
acute pancreatitis is hypertriglyceridemia. Here, we present the case
of a 45-year-old male with APL, treated with ATRA combined with
induction chemotherapy (cytarabine and idarubicin), who developed
acute pancreatitis without overt hypertriglyceridemia. This finding
suggests that hypertriglyceridemia might not be the sole contributing
factor in the pathogenesis of ATRA-induced acute pancreatitis and that
attention should be paid to the possibility that ATRA treatment causes
acute pancreatitis in the absence of overt hypertriglyceridemia.?

Pancreatitis (Inflammation of the pancreas)

    Does or has  anyone in your friend?s family have or had
pancreatitis? ?HP is a genetic condition. This means that the risk of
pancreatitis and pancreatic cancer can be passed from generation to
generation in a family. The gene associated with HP is called PRSS1. A
mutation (alteration) in the PRSS1 gene gives a person an increased
risk of pancreatitis and pancreatic cancer. Mutations in two other
genes, called SPINK1 and CFTR, have also been linked to HP. However,
it is unknown if mutations in these genes cause an increased risk of
pancreatic cancer. Researchers believe that other genes may be
associated with HP, and studies are ongoing to learn more about this

How is HP inherited?
Normally, every cell has two copies of each gene: one inherited from
the mother and one inherited from the father. HP follows an autosomal
dominant inheritance pattern, in which a mutation happens in only one
copy of the gene. This means that a parent with a gene mutation may
pass along a copy of their normal gene or a copy of the gene with the
mutation. Therefore, a child who has a parent with a mutation has a
50% chance of inheriting that mutation. A brother, sister, or parent
of a person who has a mutation also has a 50% chance of having the
same mutation.?

   ?It is thought that the damage to the pancreas occurs as the result
of digestive enzymes leaking into the pancreas and starting to digest
it. This sets up inflammation, and when the inflammation settles, the
scarring process distorts the pancreas making further attacks of
inflammation likely. Thus a vicious cycle develops.

As a result of prolonged damage to the pancreas, the pancreas fails to
produce enough digestive enzymes to permit adequate digestion of food.
This leads to weight loss and the frequent passage of pale greasy
stools which contain excess amounts of fat. Further, the destruction
of the cells which produce insulin may lead to the development of

Some causes of pancreatitis:
?  high levels of calcium in the blood
?  abnormalities in anatomy which are usually present at birth
?  cystic fibrosis 
?  high blood fats (hypertriglyceridaemia)
?  in rare cases, some drugs can cause pancreatitis
?  in a number of cases no specific cause can be identified, a
condition known as idiopathic pancreatitis.

?Some patients will have obstruction to the small ducts in the
pancreas by small stones, and this is thought to cause back pressure
and destruction of the pancreas.?

?Preventing attacks

The long-standing principle has been to try and rest the pancreas.
This involves giving pancreatic supplements such as Creon (which
contain pancreatic enzymes in high concentration) together with drugs
which reduce acid secretion by the stomach. Patients should also
follow a low-fat diet.

These measures reduce the presence of fat in the duodenum, reduce acid
in the duodenum and reduce the need for pancreatic enzyme secretion.
These measures are very successful in about a third of patients,
moderately successful in a third and unhelpful in a third.?
Please see this site and all links I have posted for complete information.

??A high level of fat (triglycerides) in the blood. The level of
triglycerides needed to cause pancreatitis is not known.
?A family history. Chronic pancreatitis runs in some families.
?Overactive parathyroid glands, resulting in too much calcium in the blood.
?Structural problems of the pancreas or the bile and pancreatic ducts,
especially a condition in which the pancreas is divided and has two
main ducts (pancreas divisum).

Other factors that can increase your risk of pancreatitis include:
?Having cystic fibrosis. Some, but not all, people with cystic
fibrosis develop pancreatitis.
?Taking certain medicines, including estrogen therapy and some antibiotics.
?Being exposed to some viruses (such as Coxsackie virus B,
Epstein-Barr, mumps, cytomegalovirus, varicella, and hepatitis A and
?Being exposed to some bacteria, such as the type that causes tuberculosis.
?Being exposed to toxins such as scorpion venom or industrial poisons.
?Having an injury to the abdomen, such as from a car accident.
?Having medical procedures, including surgery of the pancreas or other
abdominal surgery, heart surgery, or endoscopic retrograde
cholangiopancreatogram (ERCP).
?Being pregnant. 
?Having preexisting high triglycerides.
?Having a pancreatic tumor.
?Being obese.

   ?Acute pancreatitis is a condition that develops when the pancreas
is damaged by an inflammation that leads to swelling and sometimes to
necrosis (death) of parts of the pancreas. In about 85% of patients,
acute pancreatitis is a mild disease and is associated with a rapid
recovery within a few days of onset of the illness.

In about 15-20% of patients, acute pancreatitis can lead to severe
damage of the pancreas associated with the development of pancreatic
necrosis (parts of the pancreas becomes dead).?

   ?The chief causes of acute pancreatitis in adults are gallstones,
other gallbladder (biliary) disease, and alcohol use. Other causes
?	Viral infection (mumps, coxsackie B, mycoplasma pneumonia, and campylobacter)
?	Traumatic injury
?	Pancreatic surgical procedures 
?	Common bile duct surgical procedures 
?	Certain medications (especially estrogens, corticosteroids, thiazide
diuretics, and azathioprine)
 Acute pancreatitis may also be caused by an abnormal structure of the
pancreas, genetic factors (hereditary pancreatitis), high lipid levels
in the blood (hypertriglyceridemia), and complications of cystic
The mechanism that causes pancreatitis is not well known. It is
thought that enzymes normally secreted by the pancreas in an inactive
form become activated inside the pancreas and start to digest the
pancreatic tissue. This process is called autodigestion and causes
swelling, hemorrhage, and damage to the blood vessels.

The disease affects men more often than women. Alcohol abuse is an
important risk factor.?

    ?This organ secretes digestive juices into the small intestine. It
also produces and secretes insulin to regulate blood sugar level.
Pancreatitis is the inflammation and/or infection of the pancreas. The
inflammation begins when pancreatic enzymes escape into the pancreatic
tissue. This causes chemical irritation, collection of fluid, and
blood vessel congestion. There may be severe pain, fever, nausea,
vomiting, and elevated blood pressure. After one of these episodes,
the irritation and symptoms generally subside, although there may be
bleeding, formation of pus or the death of pancreatic tissue. Severe
attacks can cause the skin to become cold and/or moist with a below
normal body temperature. Shock and dehydration may follow.?

?In severe cases of acute pancreatitis the pancreas becomes infected,
requiring antibiotic treatments. In these cases, hospitalization may
be necessary with intravenous fluid replacement therapy to restore
blood volume. Endoscopic surgery may be performed to remove gallstones
if they are blocking drainage of the pancreas or rarely, the pancreas
may be removed. For those with another type of acute pancreatitis,
hemorrhagic pancreatitis, the death rate is high, particularly when
other health problems such as heart, kidney or liver disease are

?Four to six weeks after the onset of acute pancreatitis, pancreatic
abcesses (pseudocysto) may form in a small number of patients. These
may be surgically removed, if necessary. Pseudocysts occur in about
20% of those with acute pancreatitis. These are collections of fluid,
enzymes and blood which amass in the pancreas about one to four weeks
after the onset of pancreatitis. These often clear up untreated while
some require surgical drainage. Patients having acute pancreatitis
generally make a full recovery if the underlying cause can be

    ?The chief causes of acute pancreatitis in adults are gallstones,
other gallbladder (biliary) disease, and alcohol use. Viral infection
(mumps, coxsackie B, mycoplasma pneumonia, and campylobacter),
hereditary conditions, traumatic injury, pancreatic or common bile
duct surgical procedures and certain medications (especially
estrogens, corticosteroids, thiazide diuretics, and azathioprine) are
other causes. Pancreatitis without any apparent cause- this is known
as idiopathic pancreatitis.

The exact cause of acute pancreatitis may differ among different
patients, but in general it is not well understood. It is thought that
enzymes normally secreted by the pancreas in an inactive form become
activated inside the pancreas and start to digest the pancreatic
tissue. This process is called autodigestion and causes swelling,
hemorrhage, and damage to the blood vessels. An attack may last
several days and the pain may be severe.

?Prognosis of Acute Pancreatitis  - Patients usually recover fully
from acute pancreatitis and do not experience recurrence if the cause
is removed. Alcohol consumption should be eliminated even if it is not
the determined as the cause of the disease. Smoking, which stresses
the body's defenses against inflammation, should be stopped. If
gallstones were the cause, then removal of the gallbladder is required
to prevent further attacks. For those patients in whom a cause is not
readily identified, there should be consideration of other diagnostic
testing such as endoscopic ultrasound.? You said gallstones were
already ruled out?

This is an article for purchase, but the title gives us a clue: CASE
REPORT: Acute Pancreatitis Induced by Diffuse Pancreatic Invasion of
Adult T-cell Leukemia/Lymphoma Cells

The same report as above is $40. I?m willing to bet you can locate
this article in the Huntsman library, or ask the doctor to download a


   ?Outlook in Adults with ALL. Adults tend to have a more severe
condition than children, even if they are carrying the same ALL genes.
Between 60 - 80% of adults with ALL can expect to achieve full
remission with standard treatments and between 35 - 40% survive beyond
2 years with aggressive treatments. Younger adults with ALL have
better long-term survival rates than older adults with the disease.?

?Previous chemotherapy and exposure to radiation may affect the risk
of developing ALL.
Possible risk factors for ALL include the following:
?	Being male.
?	Being white.
?	Being older than 70.
?	Past treatment with chemotherapy or radiation therapy.
?	Exposure to atomic bomb radiation.
?	Having a certain genetic disorder such as Down syndrome.

    ?In acute leukemia, the bone marrow cells are unable to properly
mature. Immature leukemic cells, which are often called blasts,
continue to reproduce and accumulate. Without treatment, most patients
with acute leukemia would live less than a few months. Some subtypes
of acute leukemia respond well to treatment and many patients are
cured, while other types of acute leukemia have a less favorable
outlook. Some of the reasons for this will be discussed later on in
this document.?

   ?ALL results from an acquired (not inherited) genetic injury to the
DNA of a single cell in the bone marrow. The disease is often referred
to as acute lymphoblastic leukemia because the leukemic cell that
replaces the normal marrow is the (leukemic) lymphoblast. The effects
are: 1) the uncontrolled and exaggerated growth and accumulation of
cells called "lymphoblasts" or "leukemic blasts," which fail to
function as normal blood cells and 2) the blockade of the production
of normal marrow cells, leading to a deficiency of red cells (anemia),
platelets (thrombocytopenia), and normal white cells (especially
neutrophils, i.e., neutropenia) in the blood.?

   Did you know that Huntsman has a Cancer Library for family and
friends of patients?

   It appears to me that Hunstman may be the best choice in your area.
Your friend may certainly request a second opinion, or change the
hematologist/oncologist if he is not pleased with the doctor.

   ?Because Huntsman Cancer Institute is a NIH designated Cancer
Center, it is required there be a separate mechanism to review study
design for cancer-related protocols. For cancer studies, IRB approval
is always contingent on approval by the CCIC. Please contact Amber
Lamph (585-0601) with questions.?

  I found this doctor who won an award for cancer research, and he is at Hunstman!:
John H. Ward, MD 
Director, Patient Care Center
Huntsman Cancer Institute
University of Utah
Salt Lake City, UT

Choosing a doctor or cancer treatment facility

Additional Reading


Other resources

CNN, About ALL

Autoimmune Pancreatitis

   There you go! I hope this answer has helped you out! I could find
no one doing research in this area, probably because pancreatitis it
is not very common in ALL.

   I just saw your clarification mentioning you would like to have
this information for tonight. I?m sorry I probably missed your
deadline, but I needed the time to do a complete and thorough search.
There is not a great deal of information on ALL and pancreatitis.
Please check each link for further information.

   If any part of my answer is unclear, please request an Answer
Clarification, and allow me to respond, before you rate!

   I wish your friend and you all the best; how lucky he is to have a
concerned friend like you!

Sincerely, Crabcakes

Search Terms
acute lymphocytic leukemia  + metastasis
Pegaspargase + pancreatitis
Pegaspargase + pancreatic inflammation
drugs that precipitate pancreatitis
methotrexate + pancreatitis
treating adult acute lymphocytic leukemia
acute lymphocytic leukemia + lymph + pancreas
pancreatitis + leukocytosis
pancreatitis + neutropenia
Subject: Re: ASAP cancer related question
From: littlolme-ga on 01 Nov 2006 10:19 PST
I just wanted to say that I truly hope they get to the bottom of your
friends problems and that he can be on the road to recovery soon, I
hope he may be able to get well soon. To have suffered cancer at such
a young age as 25 is scary enough... I apologise if it seems like im
invading your privacy but as you'd posted this as a question and I'd
noticed it, I somehow felt I had to comment, I know (only through the
internet but still...) a guy who is in his 20s and has leukaemia, so I
know its pretty rough to have someone you like/love/care for be
suffering from something like that... it must be hard on you both im
sure. Anyway, I hope things get sorted out and I wish you and your
friend good luck and hope there is a good outcome soon :-) (again I
just somehow felt compelled to post something...)
Subject: Re: ASAP cancer related question
From: crabcakes-ga on 01 Nov 2006 10:21 PST
How compassionate of you, littleolme! I'm sure your comment will mean
a great deal to confusionamidchaos-ga.

Regards, Crabcakes
Subject: Re: ASAP cancer related question
From: littlolme-ga on 01 Nov 2006 11:38 PST
Thanks for saying so crabcakes :-) I rarely post esp. if I dont know
anything to help answer the question posted but I thought I
would/should on this ocassion...
Subject: Re: ASAP cancer related question
From: mrtmc-ga on 09 Nov 2006 02:14 PST
I Agree With  Crabcakes, 
Littleolme that is a very compassionate comment and should touch the
heart of confusionamidchaos i know it did to me :)

I Commend You littleolme :)

Ttfn - Mrtmc :)

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