Grade 3 and 4 Toxicity Profiles During Therapy of Childhood Acute Lymphoblastic Leukemia (original) (raw)
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OALib, 2017
The most common childhood cancer is acute lymphoblastic leukemia (ALL). Chemotherapy-associated hematological toxicity is well-known; however, there are few studies on hematologic toxicity incidence in children with ALL. We investigated the severity and incidence of hematologic toxicity during intense chemotherapy processes in children treated with ALL IC-BFM 2009 protocol. The study included 41 leukemic children in standard (SR) and intermediate risk (IR) groups treated between 2011 and 2015. During the induction period, the incidence of grade 4 toxicity in neutrophil count was 60%; the incidence of grade ≥ 3 toxicity in hemoglobin level was 34%; and the incidence of grade ≥ 3 toxicity in the platelet count was 51%. Deep neutropenia duration was 36.6 ± 12.7 (18-68) days during the induction. 53% of the febrile neutropenic (FEN) episodes developed during the induction period. There were no statistical differences between SR and IR risk groups with respect to hemogram values deep neutropenia duration and the number of FEN episodes (p > 0.05, all). There was a positive correlation between the number of FEN episodes and duration of neutropenia. During the induction, the mean neutrophil count remained between 0.5-1 × 10 9 /L. FEN episodes most commonly developed during the induction phase.
Acta Haematologica Polonica, 2020
IntroductionLeukemia belong to 31% of all childhood malignancies. Acute lymphoblastic leukemia (ALL) is the most frequent type of pediatric leukemia accounting for 80–85% of all cases. Progress in diagnostics and therapy of leukemia is dependent on international cooperation. The objective of the study was the analysis of non-hematological toxicity during intensive chemotherapy according to two consecutive intercontinental protocols.Patients and methodsA total number of 210 children diagnosed for ALL who were treated in single center between 2002 and 2018 were divided in two groups defined by therapeutic protocol: ALL IC-BFM 2002 (group 1) and ALL IC-BFM 2009 (group 2). Data were entered prospectively from 2002 into international ALL IC-BFM 2002 and ALL IC-BFM 2009 registry. Non-hematological toxicity was analyzed according to the criteria followed in protocols, compatible with CTCAE criteria.ResultsThe most frequent toxicities included hepatic toxicity with transaminitis and hyperbi...
Clinical Lymphoma Myeloma and Leukemia, 2020
The present study evaluated the acute complications and survival rates of childhood acute lymphoblastic leukemia. We assessed 110 patients treated with the Children's Oncology Group protocol from 1999 to 2014. Childhood acute lymphoblastic leukemia, although categorized as a curable malignancy owing to the improvements in treatment strategies in recent years, can cause acute complications affecting various systems. Background: We evaluated the acute complications that occurred during the treatment of childhood acute lymphoblastic leukemia (ALL) and documented the survival rates of children with ALL. Materials and Methods: We retrospectively evaluated 110 children with a diagnosis of ALL treated with the Children's Oncology Group protocol from 1999 to 2014. The demographic, clinical, and laboratory data of 110 patients and acute complications of eligible and evaluable 105 patients were recorded. Results: Of the 110 patients, 65 were male and 45 were female. The mean age at admission was 8.3 AE 5.2 years. Ninety-seven patients (88.2%) had been diagnosed with preeB-cell ALL, 11 (10%) with T-cell ALL, 1 (0.9%) with mixed phenotype acute leukemia, and 1 (0.9%) with mature B-cell acute leukemia. Of the 110 patients, 40 (36.3%) were in the standard-risk group and 70 (63.7%) were in high-risk group. Of the 110 patients, 105 had been followed up regularly and evaluated for acute complications. Infection was the most common complication (n ¼ 93; 88.5%), followed by gastrointestinal (n ¼ 29; 27.6%), neurologic (n ¼ 28; 26.6%), metabolic/ endocrine (n ¼ 16; 15.2%), drug-related hypersensitivity (n ¼ 16; 15.2%), avascular necrosis (n ¼ 13; 12.3%), thrombotic (n ¼ 11; 10.4%), severe psychiatric (n ¼ 2; 1.9%), and various other (n ¼ 12; 11.4%) complications. Of the 110 patients, 98 were assessed in terms of survival analysis. The 5-and 10-year overall survival rates were both 85.9% (standard error [SE], 3.6%). The relapse-free survival rates at 1, 3, and 5 years were 97.9% (SE, 1.5%), 91.3% (SE, 3%), and 86.3% (SE, 3.7%), respectively. Conclusion: Childhood ALL, although categorized as curable malignancy owing to the improvements in treatment strategies in recent years, can cause acute complications affecting various systems. Thus, patients should be treated and followed up by multidisciplinary medical teams with high expertise.
Middle East Journal of Cancer, 2020
Background: Acute lymphoblastic leukemia (ALL) is a heterogeneous group of lymphoid neoplasms resulting from the proliferation of malignant lymphoid cells. The aim of this study was to evaluate treatment-related complications in children with ALL receiving the Medical Research Council (MRC) UKALL X protocol. Methods: In this retrospective cross-sectional study, children with ALL receiving the MRC UKALL X protocol from 2008 to 2015 in Bahrami University Hospital, Iran, were enrolled. The clinical and morphological features were analysed and treatment-related complications were assessed. Results: Out of 67 children with ALL receiving the MRC UKALL X protocol, 44 (65.6 %) were boys and 23 (34.4%) were girls. Seven patients (10.7%) relapsed in the three years of diagnosis, and 50 children (74.6%) had an overall survival of three years. Average age in three-year-survival group and mortality group was 6.92 (SD: 3.96) and 6.35 (SD: 7.47), respectively (P= 0.38). Conclusion: Overall surviva...
Role of infection in the death of children with acute lymphoblastic leukaemia
Archives of Disease in Childhood, 1977
upon Tyne SUMMARY Twenty-four consecutive deaths from a total of 70 children receiving treatment for acute lymphoblastic leukaemia (ALL) have been reviewed. An attempt has been made to ascribe the cause of death to either infection, haemorrhage, the leukaemia itself, or a combination of these factors. No child was free of infection at death. Infection, with or without haemorrhage, was responsible for the deaths of all 15 children whose leukaemia had not relapsed. Although infection was present at death in all 9 children whose leukaemia had relapsed, the leukaemia process itself was also a major contributing factor. Viruses were associated with death in many of the children and may be emerging as important pathogens in children with ALL. Familiarity with a protocol may be an important factor in the prevention of fatal infections in such children. Centralization of treatment is necessary if this expertise is to be acquired.
Analysis of complications during treatment of children with acute lymphoblastic leukemia
Boletín médico del Hospital Infantil de México
Complications experienced by children with acute lymphoblastic leukemia (ALL) are successfully treated as timely support has improved with blood products, intensive care, antibiotics and trained medical specialists. 1 It has been shown that the survival rate of children with ALL, in addition to timely and multidisciplinary treatment, depends on compliance with international standards and having the necessary infrastructure. 2,3 AbSTRACT background. Infectious, hematologic and metabolic complications in children with acute lymphoblastic leukemia (ALL) can be successfully treated. The objective of this study was to determine the clinical characteristics of patients with complications that contribute to mortality in children with ALL and healthcare processes through adherence to the clinical guidelines of the Children's Oncology Group (COG). methods. We performed a case-control study in nine hospitals affiliated with the Seguro Popular insurance program, analyzing clinical characteristics and treatment of febrile neutropenia, septic shock, severe anemia, hemorrhage, lysis tumoral syndrome and hyperleucocytosis. Results. Confirmation of fever and profound neutropenia in patients with septic shock and febrile neutropenia influences mortality. Antibiotic administration delays treatment and lack of adherence to the clinical guidelines of the COG. There were no clinical differences in severe anemia and hemorrhage or in the health care processes. Conclusions. Lack of adherence to clinical guidelines has had an impact on mortality in infectious complications. There is a lack of systematization in some care processes. In certified hospitals, there are reports that patients died from avoidable complications.
British Journal of Haematology, 2001
In the last 20 years, the survival rate for children with acute lymphoblastic leukaemia (ALL) has markedly improved, largely owing to a decrease in relapses. However, children still die from complications of treatment and these are potentially preventable. We have analysed data from three large consecutive national protocols for ALL from 1980 to 1997 [Medical Research Council United Kingdom ALL (MRC UKALL) trials VIII, X and XI] to compare the incidence and causes of treatment-related deaths (TRD). The percentage of TRD has fallen from 9% to 2% (UKALL VIII to XI), largely as a result of a decrease in fatal infections. Deaths during induction have fallen from 3% to 1%, the main causes of death being bacterial, followed by fungal infection, while other causes, chiefly haemorrhage, have not declined. Remission deaths also decreased from 6% to 1%,