Frequency of Infectious Mortality at the End of Induction Chemotherapy in Acute Lymphoblastic Leukemia and Lymphoma Patients: Findings From a Tertiary Care Cancer Center

Wali, Rabia; Anjum, Sadia; Amjad, Asim; Shaheen, Najma; Khan, Saadiya

doi:10.7759/cureus.13208

Cited by 5 publications

(6 citation statements)

References 15 publications

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“…), Rabia et al (2021) reported 10 % death in ALL patients during the course of induction chemotherapy in a tertiary care cancer hospital 8. This study states, sepsis occurred in 76.6% patients (46/60).…”

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Serum IgG and IgA level in children with acute lymphoblastic leukaemia and its relation with outcome in induction chemotherapy

Nahar,

Karim,

Rahman

et al. 2024

Haematol J Bangladesh

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Background: Immunosuppression in children with Acute Lymphoblastic Leukaemia (ALL) escalates vulnerability to severe infectious complications which leads to higher morbidity and mortality rates among patients. Immunoglobulins are important part of defence mechanism of the body contributing to the humoral immunity. Of all the immunoglobulins, IgG and IgA represents most common type of antibody in blood circulation and provides most long-lived antibody-based immunity against invading pathogens. In earlier years, studies have shown that, serum immunoglobulins are found to be decreased during chemotherapy and this reduction is related with severe sepsis and death in patients. Early identification of immune status can be much useful for assessment of severity and better risk stratification of the patients. Objective: Evaluation of serum IgG and IgA levels in children with ALL and its relationship with sepsis in induction phase of chemotherapy. Method: This prospective observational study was conducted in the Departments of Paediatric Haematology & Oncology and Department of General Paediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka. During January 2022 to December 2022, a total 60 paediatric patients of newly diagnosed ALL were included as study population. As control, 30 patients were included in this study from General paediatrics and Paediatric Haematology & Oncology, BSMMU to compare baseline immunoglobulin levels with the study group. Complete history and physical examination of all patients were undertaken, and all prior reports were collected. Serum IgG and IgA level assay was done before starting chemotherapy and at the end of induction chemotherapy in the study group. Patients diagnosed with ALL received chemotherapy modified UK-ALL 2003 protocol. History and data of any event of sepsis, along with the symptoms of complications were taken from all patients during the course of induction chemotherapy. Results: The mean age of the cases were 5.49±3.15 (mean ± SD) years, which ranged from 1.9 to 15 years. Among the cases, 41 patients (68.3%) were male and 19 (31.7%) females. Seven (11.7%) subjects expired during induction chemotherapy. In comparison to the control group the mean IgG level in the study group was lower at baseline and even lower at the end of induction and it was statistically significant (p<0.05). The mean IgG level was low in patients with septic events in comparison with the patients with no septic events. Difference of mean of IgG between septic and aseptic patients was significant only at the end of induction chemotherapy (p<0.05). The mean IgA level was low in study group in comparison with the control group and it was statistically significant (p<0.05) only at the end of induction chemotherapy. The mean IgA level was low in patients with septic events in comparison with the patients with no septic events. Difference of mean of IgA between septic and aseptic patients was significant (p<0.05). Based on the receiver-operator characteristic (ROC) curves of change of S. IgG, with a cut off value 50% decreased from baseline having 68.8% sensitivity and 29.7% specificity for prediction of sepsis. Considering change of S. IgA with a cut off value 50% decreased from baseline having 67.6% sensitivity and 27.5% specificity for prediction of sepsis. Conclusion: In our study, the mean IgG and IgA level of the cases were low in comparison to the control group. The mean IgG and IgA level of the patients were lower who had infectious complications, and it was more marked after induction chemotherapy. Therefore, evaluation of immunoglobulin profiles is recommended to be considered in patients with ALL in further studies.

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Serum IgG and IgA level in children with acute lymphoblastic leukaemia and its relation with outcome in induction chemotherapy

Nahar,

Karim,

Rahman

et al. 2024

Haematol J Bangladesh

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“…Кроме этого, следует отме тить и высокий процент неотложных состояний на момент обращения, прежде всего обусловленных раз витием гиперлейкоцитоза,среди прочего может сви детельствовать о поздней диагностике основного за болевания. Адекватный объем противомикробной, инфузионной, гемотрансфузионной терапии, а также контроль над СОЛО и возможными электролитными нарушениями будут являться ключевыми факторами прогноза на инициальном этапе ведения пациентов с ОЛ [6,27].…”

Section: Discussionunclassified

“…Цитотоксическое, миелосупрессивное и иммуно супрессивное действия противоопухолевых препаратов в периоде ИХТ являются причинными факторами развития бактериальных и грибковых инфекций [6,27]. Следует отметить, что и нарушение барьерной функции кожи и слизистых оболочек, в первую очередь желудочнокишечного тракта, будет определять риски транслокации эндогенной флоры с развитием тяжелых инфекционновоспалительных заболеваний [28].…”

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Analysis of acute leukemia complications in children at the disease onset and during induction

Lygina,

Andreeva,

Rusina

et al. 2023

Onkogematologiâ

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Background. Despite the progress achieved in the treatment of acute leukemia (AL) in children, complications, both at the disease onset and those resulting from antitumor therapy, remain the main cause of early mortality, which varies from 3 to 20 %.Aim. To assess the frequency, severity, etiology, risk factors, and outcomes of AL complications in children at the disease onset and during induction chemotherapy (ICT).Results. The study analyzed 92 cases of AL in children aged from 5 months to 17 years. 75 patients had acute lymphoblastic leukemia (ALL), 17 had acute myeloid leukemia (AML). In 1 (1.3 %) patient with ALL and in 5 (29.4 %) with AML, a concomitant diagnosis was Down syndrome. At the AL onset, 34 (36.9 %) patients were diagnosed with infection, of which 27 (36 %) and 7 (41.2 %) patients had ALL and AML, respectively. In both cohorts, febrile neutropenia (55.5 %; n = 15 vs. 14.3 %; n = 1), pneumonia (25.9 %; n = 7 vs. 71.4 %; n = 5), enterocolitis (7.4 %; n = 2 vs. 14.3 %; n = 1) predominated in both cohorts for AML and ALL, respectively. Due to uncontrolled infection in 5 (29.4 %) patients with AML and 13 (17.3 %) with ALL, ICT was delayed until the condition stabilized and the infection was controlled. During ICT, the incidence of infectious complications was 81.3 % (n = 61) and 100 % (n = 17) in patients with ALL and AML, respectively. The most common types were enterocolitis (41.2 %; n = 7 vs. 34.4 %; n = 21), febrile neutropenia (29.4 %; n = 5 vs. 37.7 %; n = 23), pneumonia (47.1 %; n = 8 vs. 29.5 %; n = 18), catheter-associated bloodstream infection (11.8 %; n = 2 vs. 8.2 %; n = 4) in AML and ALL, respectively. By etiology, bacterial infections predominated, accounting for 32 % (n = 8) and 36.8 % (n = 35) in the AML and ALL groups, respectively. More cases of invasive mycoses were reported in AML patients – 23.5 % (n = 4) versus 14.8 % (n = 11). Non-infectious complications were diagnosed in 32.6 % (n = 30) of patients with a predominance in ALL group (34.6 %; n = 26 vs. 23.5 %; n = 4). Hyperleukocytosis at the leukemia onset caused such complications as leukostasis (11.8 %; n = 2) and acute tumor lysis syndrome (11.8 %; n = 2). The most common post-cytostatic complications in ALL were vincristine polyneuropathy (61.5 %; n = 16), hemorrhagic syndrome (15.4 %; n = 4), methotrexate-induced encephalopathy (15.4 %; n = 4), acute tumor lysis syndrome (11.5 %; n = 3). In AML cases, the most common type of non-infectious complications were hemorrhagic (75 %; n = 3). Induction mortality in the ALL group was 2.6 % (n = 2), in the AML group it was higher – 11.8 % (n = 2), however, it should be noted that all deaths were registered in children with Down syndrome. The main cause of mortality in both groups was severe infections secondary to chemotherapy-induced hematopoietic aplasia. There were no deaths associated with non-infectious complications or chemotherapy-induced toxicity.Conclusion. The main type of toxicity in children at the AL onset and during ICT remains infectious complications of various etiologies, while in AML patients a higher frequency of invasive mycoses is registered (23.5 % vs. 14.8 %). Despite the high incidence of chemo-induced toxicity, the mortality rate in ALL remains low, amounting to 2.6 % in our cohort. In the AML group, mortality was higher – 11.8 %, but it should be noted that all cases occurred in patients with Down syndrome. There were no deaths due to non-infectious complications in any of the study cohorts.

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“…Многократные госпитализации больного в хирургические и терапевтические стационары и ОРИТ привели к присоединению полирезистентной микрофлоры, персистенция которой неизбежно влечет летальный исход в постхимиотерапевтическом периоде. Приведенный клинический пример больного Г. подтверждает мировые данные о необходимости как ранней диагностики лимфом, так и недопустимости длительного нахождения пациента на диагностическом этапе в различных отделениях стационара [8,9].…”

Section: Discussionunclassified

A problem of multi-drug resistant infectious in pediatric lymphoma treatment

Валиев

Матинян

Епифанова

et al. 2021

Ross. ž. det. gematol. onkol.

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The basis of modern high-effective therapeutic programs for pediatric lymphomas is an intensive, risk-adopted therapy, which complicated with myelosuppression. In myelotoxic agranulocytosis condition infectious complications are often and its treatment results depend on duration and level of agranulocytosis, and sensitivity of microorganism to antimicrobial agents. Multi-drug resistant strains of Pseudomonas aeruginosa, Acinetobacter baumannii and etc. are a serious problem in supportive care of postchemotherapy complications, when even multidisciplinary approach with pediatric oncologists/hematologists, microbiologists, clinical pharmacists, surgeons, specialists in extracorporeal blood purification modalities and intensive care are ineffective.

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Frequency of Infectious Mortality at the End of Induction Chemotherapy in Acute Lymphoblastic Leukemia and Lymphoma Patients: Findings From a Tertiary Care Cancer Center

Cited by 5 publications

References 15 publications

Serum IgG and IgA level in children with acute lymphoblastic leukaemia and its relation with outcome in induction chemotherapy

Serum IgG and IgA level in children with acute lymphoblastic leukaemia and its relation with outcome in induction chemotherapy

Analysis of acute leukemia complications in children at the disease onset and during induction

A problem of multi-drug resistant infectious in pediatric lymphoma treatment

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