Vol 51, No 3 (2020)
Published online: 2020-09-01

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Acute non-hematological toxicity of intensive chemotherapy of acute lymphoblastic leukemia in children

Ewa Demidowicz1, Natalia Bartoszewicz1, Krzysztof Czyżewski1, Joanna Cisek1, Anna Dąbrowska1, Robert Dębski1, Magdalena Dziedzic1, Marlena Ewertowska1, Elżbieta Grześk1, Agnieszka Jatczak-Gaca1, Andrzej Kołtan1, Sylwia Kołtan1, Anna Krenska1, Monika Łęcka1, Piotr Księżniakiewicz1, Agata Marjańska1, Monika Pogorzała1, Monika Richert-Przygońska1, Barbara Tejza1, Anna Urbańczyk1, Hanna Żołnowska1, Mariusz Wysocki1, Jan Styczyński1
DOI: 10.2478/ahp-2020-0029
Acta Haematol Pol 2020;51(3):164-171.



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.


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.


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.

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