Abdominal Complications During Treatment for Pediatric Acute Myeloid Leukemia

Abstract

Acute myeloid leukemia (AML) accounts for 15% to 20% of childhood leukemias. Because of high-intensive therapy, up to 5% of patients suffer from treatment-related mortality (TRM). Abdominal complications are frequent, however, literature on this subject is sparse. We aimed to characterize severe abdominal pain (AP) and hyperbilirubinemia experienced by pediatric AML patients treated according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO)-AML 2004 protocol (n=313). Patients were censored at hematopoietic stem cell transplantation and relapse. Toxicity information was collected prospectively. Additional information was requested retrospectively from the treating centers. Sixteen episodes of hyperbilirubinemia and 107 episodes of AP were reported. The treating centers deemed infection (30%) and typhlitis (18%) as the most frequent causes of AP. Six patients developed appendicitis (2%). Patients experiencing concurrent AP and sepsis had a high risk of TRM (36%, n=4). Eighty percent of episodes with hyperbilirubinemia fulfilled the European Society for Bone and Marrow Transplantation criteria for sinusoidal obstruction syndrome. In conclusion, abdominal complications were frequent with infection considered the predominate cause. Most patients with hyperbilirubinemia fulfilled the criteria for sinusoidal obstruction syndrome. AML treatment might be associated with appendicitis. Patients suffering from concurrent AP and sepsis had a high risk of TRM indicating that high awareness of abdominal complications is essential to reduce mortality, especially during sepsis.

Neutropenic Enterocolitis as a Complication of Autologous Stem Cell Transplant in Patients With Multiple Myeloma: A Case Series

“…It is classically characterized by transmural inflammation of the caecum and the appendix with involvement of the ascending colon and ileum in patients with severe myelosuppression. It was first described in pediatrics during the induction of leukemia [ 3 ]. The exact incidence of this manifestation is still unknown; a systematic review published in 2005 suggested an incidence of 5.6% in adults hospitalized for hematologic malignancies or under chemotherapy for solid tumors [ 2 ].…”

Supportive care in pediatric acute myeloid leukemia:Expert-based recommendations of the NOPHO-DB-SHIP consortium

“…The incidence of typhlitis in pediatric AML varies in different studies between 14-38% due to varying definitions of typhlitis: clinical signs only, clinical signs plus radiology, or histopathologic confirmation [64][65][66].…”