When and why do children develop hyperglycemia during acute lymphoblastic leukemia therapy?

OBJECTIVE: To identify risk factors for hyperglycemia and evaluate the impact on outcomes among pediatric patients with acute lymphoblastic leukemia undergoing chemotherapy. METHODS: We conducted a retrospective cohort study involving 188 pediatric patients treated for acute lymphoblastic leukemia at a Brazilian cancer referral center between 2004 and 2017. Hyperglycemia was assessed during the induction and consolidation phases of chemotherapy. Associations with patient and disease characteristics were examined through multivariate analysis. Outcomes analyzed included severe infections, relapse, and mortality. RESULTS: Hyperglycemia occurred in 43.6% of patients, predominantly during the induction phase. Pubertal status at diagnosis, younger age, and high relapse risk classification were independently associated with increased hyperglycemia risk. Puberty conferred a nearly 8-fold increased risk. However, hyperglycemia was not associated with increased risk of infections, relapse, or mortality. Higher mortality was observed among patients with overweight/obesity and those with pancreatitis or recurrent infections. CONCLUSION: Hyperglycemia was a frequent early adverse event in pediatric acute lymphoblastic leukemia treatment, particularly among pubertal patients and those at high relapse risk. Despite its high incidence, hyperglycemia was not associated with worse clinical outcomes in this cohort. These findings underscore the importance of early identification and monitoring, particularly during high-risk treatment phases.