Aim: To analyze the nutritional status of children with pediatric Acute Lymphoblastic Leukemia (ALL) at presentation. Study design: Descriptive prospective study Place and duration of study: Department of Paediatric Haematology Oncology, Children Hospital, Lahore from March 2018 to April 2019. Methodology: A total of 195 children diagnosed as acute lymphoblastic leukemia on bone marrow biopsy were included. Anthropometric measurements were taken for each patient. Results: Out of 195 diagnosed patients with ALL, majority were having B-cell ALL 165(84.6%) and 30(15.4%) T-cell ALL. There was almost equal number of both standard and high risk patients (49% vs 51%) respectively. Mean age of children was 6.79±3.78 years and there was male predominance 120(61.5%). The percentage of children having weight for age <5th centile was 91(47), only 8(4%) were overweight or obese. Children under the age of five years had a slightly higher propensity of weight <5th centile i.e. 47(51.6%) as compared to older age group 5-10 years 26(28.7%) and >10 years 18(19.7%) (p=0.295).Similarly height for age was <5th centile in 50(26%) children in total, and in under 5 year age group 26(13.3%) but there was no statistically significant difference related to age above 5 years (p=0.547). Conclusion: Pediatric ALL has overall high prevalence of under nutrition and both weight for age and height for age is lower in under-five children as compared to older age group. Keywords: Children, cancer, nutrition, malnutrition, Acute Lymphoblastic leukemia
Objective: To determine the proportion of treatment-related mortality (TRM) among mortalities of Pediatric Acute Lymphoblastic Leukemia (ALL), to identify probable causes and risk factors. Methods: An observational; retrospective, cohort study. Pediatric patients of ALL who expired during treatment were enrolled. Death due to relapse and deaths before treatment were excluded. Retrospective data was collected from ward record and analyzed in SPSS 16. Results: Total 247 patients of ALL expired while 144 patients were enrolled as per inclusion criteria. The proportion of TRM was 58.3%. Median age was 5 years. Male-to-female ratio was 1.3:1. Commonest cause of TRM was sepsis (n=126, 87.5%), followed by hemorrhagic complications (n=11, 7.6%), drug toxicity (n=4, 2.8%), tumor lysis syndrome (n=2, 1.4%) and thromboembolism (n=1, 0.7%). Significant factors associated with TRM were weight-for-age, immunophenotype, reason for admission and absolute neutrophil count. Conclusion: Treatment-related mortality though potentially avoidable is still a major cause of death among pediatric patients of ALL in low-middle income countries. Sepsis is the most common cause and infection prevention and control is vital in improving survival. Best supportive care must be made available for the patients on induction chemotherapy, with concomitant malnutrition, high-risk immunophenotype and profound neutropenia. Continuous...
Background: Infection is the major cause of morbidity and mortality in children with cancer. Chemotherapy induced febrile neutropenia-associated mortality is much higher in low-middle-income countries than in high-income countries, emphasizing the need of prevention, early identification and timely management of infection related complications in these children. Objective of this prospective study was to analyze the burden of chemotherapy induced febrile neutropenia and to assess the leading risk factors. Patients and methods: Prospective cohort study was done in 100 patients with febrile neutropenia (fever of 38.3℃ and ANC <500) admitted in the Haematology/Oncology Department of Children’s Hospital Lahore (CHL) from July to August 2016. All the children on curative chemotherapy were included in this study and children with relapse and on palliation were excluded from this study. Risk factors including knowledge of parents and caregivers about febrile neutropenia, travel time from home to hospital and duration of symptoms at home before seeking treatment and reasons for delayed response in these children’s febrile illness, were analyzed for duration of hospital stay considered as a burden on the Haematology/Oncology Department. Data regarding their age, sex, and clinical features, baseline CBC, course of therapy, hospital stay and understanding of caregivers regarding febrile neutropenia was analyzed. The first line therapy was IV Piperacillin-Tazobactam and IV Amikacin. SPSS-16 software was used to analyze the data and a p-value of <0.05 was considered as statistically significant. Results: Total 100 patients with age ranging from <1 to 15 years were included. Male to female ratio was 1.7:1, 72% of the cases had Acute Lymphoblastic Leukaemia and 28% with solid tumors. About, 28% had last chemotherapy received in 72 hours, 30% in last week and rest in more than a week time 36% had upper respiratory tract infections, 18% gastrointestinal infections, 20% mucositis, 10% no focus found and rest 16% had other manifestations. Only 2 % presented in less than one hour of start of symptoms, 27% <24 hours, 61% in <5 days and 10% >5 days duration of symptoms. 45% had Hb <8 gm/dL, 33% had platelets <50,000 mm3, and 54% had WBC <1000 and 63% had ANC <100. 29% presented with the first episode while 51% had 3 or more febrile neutropenia episodes. 28% cases stayed 1 hour distance from CHL while 72% had to travel >1-5 hours to reach the primary treatment center. 66% received paracetamol at home, 17 had oral antibiotics while 17% had no treatment before reaching hospital. Only 19% caregivers had adequate awareness regarding adequate management of febrile neutropenia, 72% had some understanding while 9% had no knowledge about febrile neutropenia. 46% had financial issues, 41% were unaware while, 13% showed negligence in seeking treatment. Only 2 patients stayed for a day, 46% stayed for 5 days and 48% for more than 5 days. Conclusion: Febrile neutropenia episodes accounted for 25% of monthly admissions of the Haematology/Oncology Department of Children’s Hospital Lahore. Majority of these caregivers had inadequate basic knowledge of standard management of febrile neutropenia aggravated by increased travel time from their homes to the hospital.
Down syndrome (DS) is the commonest chromosomal disorder and is considered to be the most common syndrome associated with acute leukaemia. The objective of this study was to determine the characteristics of acute leukaemia in children with DS in Pakistan. It was a retrospective, cohort study conducted over a 2-year period, and the data was analysed in SPSS 20.0 in terms of descriptive statistics. Nineteen DS patients with acute leukaemia were enrolled. The proportion of DS-acute leukaemia was found to be 1.84% among all cases of paediatric acute leukaemia. The mean age of presentation was 5.5 years ± 4.3 SD with a male to female ratio of 1.1:1. The precursor B-cell ALL was found in 13 (68.4%) and acute myeloid leukaemia was found in 6 (31.6%) patients of DS. Thirteen patients (68.4%) completed treatment, while 6 (31.6%) expired due to treatment-related toxicity. Mean overall survival was 38 months ± 5.34 SD. The status of diagnosis of DS before presentation with acute leukaemia was the only statistically significant factor associated with the outcome. Few distinct characteristics of DS-acute leukaemia have been found in our population. Treatment toxicity was the sole cause of treatment failure.
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