open access
Acute non-hematological toxicity of intensive chemotherapy of acute lymphoblastic leukemia in children
Affiliations- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Jurasz University Hospital 1, Bydgoszcz, Poland
open access
Abstract
Introduction
Leukemia 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 methods
A 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.
Results
The most frequent toxicities included hepatic toxicity with transaminitis and hyperbilirubinemia, infections, oral mucositis and gut toxicity with vomiting, and/or diarrhea. Non-hematological toxicity episodes calculated as a ratio per patient were comparably often observed in both the groups; however, the distribution was different. There were more grade III and less grade II toxicities. This was mainly related to significant increase in the rates of infections and transaminitis. However, there was a significant decrease in vomiting and central and peripheral neurotoxicity.
Conclusions
Intensive treatment of ALL is burdened with frequent severe toxic and infectious complications. Further progress in therapy of pediatric ALL is dependent on sophisticated supportive therapy and very well experienced and knowledgeable therapeutic team.
Abstract
Introduction
Leukemia 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 methods
A 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.
Results
The most frequent toxicities included hepatic toxicity with transaminitis and hyperbilirubinemia, infections, oral mucositis and gut toxicity with vomiting, and/or diarrhea. Non-hematological toxicity episodes calculated as a ratio per patient were comparably often observed in both the groups; however, the distribution was different. There were more grade III and less grade II toxicities. This was mainly related to significant increase in the rates of infections and transaminitis. However, there was a significant decrease in vomiting and central and peripheral neurotoxicity.
Conclusions
Intensive treatment of ALL is burdened with frequent severe toxic and infectious complications. Further progress in therapy of pediatric ALL is dependent on sophisticated supportive therapy and very well experienced and knowledgeable therapeutic team.
Keywords
acute lymphoblastic leukemia; chemotherapy; toxicity; children
About this articleTitle
Acute non-hematological toxicity of intensive chemotherapy of acute lymphoblastic leukemia in children
Journal
Issue
Pages
164-171
Published online
2020-09-01
Page views
247
Article views/downloads
377
DOI
10.2478/ahp-2020-0029
Bibliographic record
Acta Haematol Pol 2020;51(3):164-171.
Keywords
acute lymphoblastic leukemia
chemotherapy
toxicity
children
Authors
Ewa Demidowicz
Natalia Bartoszewicz
Krzysztof Czyżewski
Joanna Cisek
Anna Dąbrowska
Robert Dębski
Magdalena Dziedzic
Marlena Ewertowska
Elżbieta Grześk
Agnieszka Jatczak-Gaca
Andrzej Kołtan
Sylwia Kołtan
Anna Krenska
Monika Łęcka
Piotr Księżniakiewicz
Agata Marjańska
Monika Pogorzała
Monika Richert-Przygońska
Barbara Tejza
Anna Urbańczyk
Hanna Żołnowska
Mariusz Wysocki
Jan Styczyński