2025 Southeastern Residency Conference

Title: THE USE OF LEVOCARNITINE AND VITAMIN B IN ADULT PATIENTS WITH ACUTE LYMPHOBLASTIC LUKEMIA RECEIVING PEGASPARGASE


Authors: Veronica Bekheit, Caralyn Escobar, Hunter Burnstine, Stephen Tomasek


Background: Pegaspargase, a key component in the treatment of acute lymphoblastic leukemia (ALL), is associated with significant toxicities, including hepatoxicity, which can impact treatment tolerance and outcomes. Levocarnitine and vitamin B supplementation have been proposed as potential adjuncts to mitigate these adverse effects. This study aims to describe the utilization patterns of levocarnitine and vitamin B in adult patients with ALL receiving pegaspargase and assess trends in patient outcomes. 

Methods: A retrospective, descriptive analysis was conducted on adult patients ≥18 years old diagnosed with ALL who received pegaspargase as part of their chemotherapy regimen. Patient demographics, liver function test results, pancreatic liver enzyme levels, and levocarnitine and vitamin B supplementation regimens were gathered through a retrospective chart review. Trends in laboratory values before and after supplementation were analyzed.

Results: The group receiving both levocarnitine and vitamin B experienced a higher number of mild hepatotoxicity cases (Grades 1–2); however, instances of severe toxicity (Grades 3–4) were still observed. The use of levocarnitine and vitamin B may help maintain liver enzymes (AST, ALT, ALP) and pancreatic markers (amylase, lipase) closer to baseline levels. This suggests a potential role in reducing the severity of treatment-related toxicities.

Conclusion: Levocarnitine and vitamin B supplementation may help maintain normal liver and pancreatic enzyme levels during pegaspargase therapy. This approach shows potential to reduce treatment-related toxicities and may serve as a low-risk supportive care strategy for similar patient populations at other institutions.