Chemotherapy delays in children with acute lymphoblastic leukemia might influence the outcome of treatment

Puła, Anna; Zdunek, Maciej; Michalczyk, Kaja; Cichosz, Maciej; Młynarski, Wojciech

doi:10.5603/ahp.a2022.0007

Cited by 4 publications

(4 citation statements)

References 16 publications

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“…One of the most important prognostic factors in childhood lymphoblastic leukemia is early response to treatment. It has been proved that the hematological response to prednisone on day 8 of therapy, and the bone marrow response at later timepoints, have crucial impacts on long-term outcomes [2,16,17]. In our study, this effect was mostly seen in children treated in the period 1988-1995, when PPR was related to a more than 3-fold higher risk of death (p = 0.001) and an almost 2-fold higher risk of relapse (p = 0.019).…”

Section: Discussionmentioning

confidence: 99%

Changing risk factors in childhood acute lymphoblastic leukemia: experience from Kujawsko-Pomorski region 1976–2018

et al. 2023

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Section: Discussionmentioning

confidence: 99%

Changing risk factors in childhood acute lymphoblastic leukemia: experience from Kujawsko-Pomorski region 1976–2018

et al. 2023

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“…A total of 14 pediatric patients with T-ALL (82.35%) experience a delay during treatment, and out of these patients, 7 had a delay before the 8th day of treatment. [12] In Mangum R. study, delays of 0 to 154 days during treatment were observed, with a median of 40 days. Extreme toxicities were noticed in 32 of 537 patients and were associated with worse relapse-free survival (2.9 vs 4.7 years; P < .001), and patients with T-ALL ( P = .043) were at higher risk of developing side effects during the therapeutic protocol treatment.…”

Section: Discussionmentioning

confidence: 99%

Severe complications in the induction phase of therapy in a pediatric patient with T-cell acute lymphoblastic leukemia: A case report

Rocka,

Woźniak,

Lejman

et al. 2023

Medicine

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Rationale: Acute lymphoblastic leukemia (ALL) represents approximately 1-quarter of all new cases of childhood cancer. Although overall survival following diagnosis has improved in recent years, the toxicity of chemotherapy remains a concern. Patient concerns: We describe an 11-year-old male patient diagnosed with T-cell precursor ALL who developed compounded complications during the induction phase of chemotherapy. Patient was hospitalized in the Department of Pediatric Hematology, Oncology, and Transplantology of the Medical University of Lublin, Poland. The patient’s induction therapy was started according to the AIEOP-BFM ALL 2017 protocol IAp (International Collaborative Treatment Protocol for Children and Adolescents with Acute Lymphoblastic Leukemia). Diagnoses: Patient developed compounded complications such as cholecystitis, hepatotoxicity, pancreatitis and myelosuppression. Interventions: The patient was treated with leukapheresis, received a broad-spectrum antibiotic, potassium supplementation and hepatoprotective treatment and laparotomy cholecystectomy. Outcomes: In the available literature, there is a limited amount of similar clinical cases with multiple complications in pediatric patients with ALL. Toxicities cause delays in the treatment of the underlying disease. Lessons: In children with acute lymphoblastic leukemia, there are side effects during the treatment such as cholecystitis and pancreatitis. Complications during treatment require a quick response and modification of disease management. Abdominal ultrasound performed before treatment makes it possible to observe the dynamics of lesions. Genetic mutation analysis could allow us to more precisely respond to the possible susceptibility to and appearance of complications after the use of a given chemotherapeutic agent.

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“…The use of glucocorticoids, especially high doses, has a confirmed, although unclear, relationship with the development of AP [6]. According to current guidelines, oral steroids such as prednisone are used as part of the first stage of treatment -induction [7]. Therefore, pediatric patients may be additionally at risk.…”

Section: Glucocorticoidsmentioning

confidence: 99%

Acute pancreatitis in children with acute lymphoblastic leukemia

Maziarczyk,

Lambach,

Kura

et al. 2023

Acta Haematol Pol.

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One of the most common causes of acute pancreatitis in children are medications. These include L-asparaginase, glucocorticoids and 6-mercaptopurine, which are widely used in the therapy of acute lymphoblastic leukemia (ALL). When L-asparaginase and glucocorticoids are administered together, blood triglyceride levels increase, which consequently further enhances the risk of pancreatitis. Therefore, acute pancreatitis is a common adverse effect of ALL treatment, present in 2.3-11% of pediatric patients.The aim of this paper was to assess potential risk factors, treatment outcomes and recurrence of acute pancreatitis in children with ALL. Based on the studies conducted, we found potential risk factors, other than the drugs mentioned above, to be the patient's age at diagnosis, obesity, the type of L-asparaginase administered, and the cumulative or peak dose of L-asparaginase or other drug used. The course of pancreatitis is usually mild to moderate, and the treatment is mainly symptomatic. Moreover, a successful treatment option may be octreotide. As children who have received less than 25 weeks of L-asparaginase therapy have presented with inferior outcomes, it seems reasonable to reintroduce this drug into ALL treatment after an episode of pancreatitis. The incidence of recurrent pancreatitis after re-treatment with L-asparaginase varies depending on the study. The outcomes for children who develop acute pancreatitis during ALL treatment are usually worse compared to children without an acute pancreatitis history, but the results remain inconclusive. In conclusion, acute pancreatitis remains a serious adverse effect of ALL therapy in children, which may result in worsening patients' outcomes.

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Chemotherapy delays in children with acute lymphoblastic leukemia might influence the outcome of treatment

Abstract: This article has been peer reviewed and published immediately upon acceptance.It is an open access article, which means that it can be downloaded, printed, and distributed freely, provided the work is properly cited.

Cited by 4 publications

References 16 publications

Changing risk factors in childhood acute lymphoblastic leukemia: experience from Kujawsko-Pomorski region 1976–2018

Changing risk factors in childhood acute lymphoblastic leukemia: experience from Kujawsko-Pomorski region 1976–2018

Severe complications in the induction phase of therapy in a pediatric patient with T-cell acute lymphoblastic leukemia: A case report

Acute pancreatitis in children with acute lymphoblastic leukemia

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