Objective To analyze the clinical characteristics and risk factors of asparaginase-associated pancreatitis (AAP) in acute lymphoblastic leukemia (ALL) children treated by pegaspargase (PEG-ASP).

Methods The clinical data of 810 ALL children treated by PEG-ASP from March 2016 to March 2020 in the Children's Hospital Affiliated to Soochow University were analyzed retrospectively, and the clinical characteristics, biochemical indexes, therapeutic measures, prognosis and related risk factors of AAP were analyzed.

Results The incidence of AAP was 4.8% (39/810). There were no significant correlations of AAP with gender, immune typing and risk stratification of ALL, but the incidence of AAP increased significantly in children aged over 10 years than those aged ≤10 years (P < 0.01). 71.8% of AAP occurred during the first or second treatment in children with PEG-ASP, the median time of occurrence of AAP was 12 days after PEG-ASP exposure, and the median cumulative dose of PEG-ASP was 3 660 IU/m².92.3% of AAP children had abdominal pain; 94.9% of AAP children had increase of serum amylase or lipase more than three times of the upper limit of normal value; imaging examination showed signs of pancreatitis in 89.5% of children with AAP. A total of 39 children with AAP were improved after treatment, 8 children with AAP were cured and reused ASP related preparations, of which 3 cases had AAP again.

Conclusion Age may be one of the risk factors of AAP, and the first and second acceptance of PEG-ASP are the high incidence periods of AAP during treatment. Some AAP patients lack the characteristic clinical symptoms of pancreatitis, and AAP patients still have a high risk of recurrence when using ASP related preparations again.