Impact of Chemotherapy-Related Hyperglycemia on Prognosis of Child Acute Lymphocytic Leukemia

Abstract

Purpose: To investigate the impact of hyperglycemia during inductive treatment on the prognosis of acute lymphocytic leukemia (ALL) in children. Materials and Methods: Clinical data of 159 ALL childhood cases were reviewed. The patients were divided into the hyperglycemia group (fasting glucose≥126mg/dl and/or random blood glucose≥200mg/dl) and the euglycemia group according to the blood glucose values. The Χ2 test was performed to compare the complete remission rates of the two groups, and Kaplan-Meier and log-rank tests were performed to compare the 5-year overall and relapse-free survival. Results: The incidence of hyperglycemia in the age≥10-year-old group was higher than the younger-age group (P=0.009). Values in the interim-and high-risk groups were higher than the standard-risk group (P=0.028), while there was no significant difference between genders (P=0.056). The complete remission rates of the 2 groups demonstrated no significant difference (P=0.134), while the 5-year OS of the hyperglycemia group was lower than in the euglycemia group (83.8±6.0% vs 94.9±2.4%, P=0.014). The 5 -year RFS was significantly lower than the euglycemia group (62.9±8.7%) vs 80.2±9.1%, P<0.001). Conclusions: Children with age≥10 years old, and in the middle-and high-risk groups appear prone to complicating hyperglycemia during inductive chemotherapy, associated with lower 5-year OS and RFS.Keywords: Childhood ALL -chemotherapy-related hyperglycemia -relapse-free rate -overall survival RESEARCH ARTICLE Impact of Chemotherapy-Related Hyperglycemia on Prognosis of Child Acute Lymphocytic LeukemiaBi-Hong Zhang 1 , Jian Wang 1 , Hong-Man Xue, Chun Chen* the L-asparaginase (L-asp) and glucocorticoids are the commonly used drugs during the child ALL inductive chemotherapy, which would affect the production, release and functions of insulin, the chemotherapy-related hyperglycemia is also a common complication of child ALL, with the occurring rate as 4% to 20%, or even as high as 56% (Belgaumi et al., 2003;Sonabend et al., 2008). Currently, the report about the impacts of hyperglycemia during the inductive chemotherapy towards the prognosis of child ALL is few, and the conclusions are inconsistent. This study compares the rates of complete remission, 5-year recurrence-free survival and 5-year overall survival between the hyperglycemic ALL children and the non-hyperglycemic ALL children during the inductive chemotherapy, aiming to analyze the relationship of hyperglycemia and prognosis of child ALL.

Prevalence of Hyperglycaemia in Acute Lymphoblastic Leukaemia and Its Impact on Therapy During Induction at Jnims - A Preliminary Data

“…Zhang et al had reported that the ALL patients with hyperglycaemia achieved CR lesser than the euglycemic group (86.8% vs. 95%; p-value= 0.134) though not significant. 11 Roberson et al in their study of childhood ALL during remission induction had found that patients with hyperglycaemia during induction were less likely to achieve CR by the end of induction (p-value=0.03). 7 In our study the CR rate was lower in hyperglycaemic group vs. non hyperglycaemic group (87.5% vs 100%; p-value=0.13).…”

Effect of Chemotherapy Related Hyperglycemia on Bone Marrow Response to Induction Treatment in Children with Acute Lymphoblastic Leukemia

“…(1) • According to sex, there was a statistically significant difference between the two subgroups (p-value 0.001) as shown in table (2). • As regarding blood sugar level in the studied groups there was a significant relationship between group I and group II as shown in table (3) • Also, there was significant relationship between the two subgroups as shown in tables (4) and (5) and the ratio of patients developed hyperglycemia to euglycemia was 33 (30.3%) to 76(69.7%) • According to CBC parameters the study showed significant relationship between patients with white blood cell count ≥20×10 9 /L and patients with white blood cell count <20×10 9 /L in group IIa and group IIb at the end of the induction period on the 33rd day with no significance in other CBC parameters on the other hand, peripheral blood juvenile cells at diagnosis were >5%and by comparison between peripheral blood juvenile cells in hyperglycemic and euglycemic cases it showed that there was no significance between the two subgroups on the 8th day of induction treatment but it was significant on 15th day and 33rd day. • Bone marrow aspiration was done at the diagnosis of the 109 patients with ALL and all showed >30% blast cells in bone marrow and by evaluation of bone marrow during the period of induction there was no significant relationship between bone marrow findings at 15th day between the two subgroups but it was significant at 33th P-value < 0.05 as shown in table (7)…”

The Effect of Combination of Steroid and L-Asparaginase on Hyperglycemia in Children with Acute Lymphoblastic Leukemia (ALL)

“…Taking the incidence of hyperglycemia into consideration (the incidence being between 9,7%-56%; Lowas et al, 2009). Zhang et al, (2014) study has shown association between the incidence of hyperglycemia 5-year overall survival rate and the relapse-free survival rate. To date, there is still no official report available on the incidence rate of hyperglycemia in children with ALL receiving induction phase of chemotherapy in Indonesia.…”