Influence of Inflammatory and Oxidative Stress Pathways on Longitudinal Symptom Experiences in Children With Leukemia

Abstract

Purpose: The purpose of this study was to explore the influence of oxidative stress (F2-isoprostanes) and inflammatory (interleukin [IL]-8) biomarkers on symptom trajectories during the first 18 months of childhood leukemia treatment. Method: A repeated-measures design was used to evaluate symptoms experienced by 218 children during treatment. A symptom cluster (fatigue, pain, and nausea) was explored over four time periods: initiation of post-induction therapy, 4 and 8 months into post-induction therapy, and the beginning of maintenance therapy (12 months postinduction). F2-isoprostanes and IL-8 were evaluated in cerebrospinal fluid (CSF) samples collected at baseline (diagnosis) and then at the four time periods. The longitudinal relationships of these biomarkers with the symptom cluster were examined using the longitudinal parallel process. Results: Pain and fatigue levels were highest during the post-induction phases of treatment and decreased slightly during maintenance therapy, while nausea scores were relatively stable. Even in the later phases of treatment, children continued to experience symptoms. CSF levels of the biomarkers increased during the post-induction phases of treatment. Early increases in the biomarkers were associated with more severe symptoms during the same period; patients who had increased biomarkers over time also experienced more severe symptoms over time. Conclusions: Findings reveal that children experienced symptoms throughout the course of leukemia treatment and support hypothesized longitudinal relationships of oxidative stress and inflammatory biomarkers with symptom severity. Activation of the biomarker pathways during treatment may explain underlying mechanisms of symptom experiences and identify which children are at risk for severe symptoms.

Effect of Carrying out Continuous Nursing Based on Mobile Platform on the Life of Children with Leukemia after Discharge from Hospital

“…Due to the toxic and side effects of drugs, the treatment compliance of children with leukemia is poor, and it is more difficult to strictly follow the medical advice due to the lack of continuous nursing guidance after discharge, which is very unfavorable to improve the treatment effect and prognosis [ 14 , 15 ]. After children with leukemia are discharged from hospital, the nursing staff will apply the mobile platform to carry out continuous nursing, which can enable the medical staff to closely combine with the patients [ 16 ], and children with leukemia lack the knowledge of disease and nursing in their daily care. By using a mobile platform, medical staff can regularly release publicity materials and the contents of the next phase of prognosis, so that children and their families can have a comprehensive understanding of the knowledge of disease and nursing [ 17 , 18 ].…”

Oxidative stress in leukemia and antioxidant treatment

“…[ 4 ] The oxidative stress biomarkers make it possible to focus on the individualized treatment of diseases. [ 60 ] In the near future, targeted oxidative stress therapy combined with chemotherapy or other strategies may become a kind of useful clinical treatment for various blood diseases. [ 61 , 62 ] However, at the present stage, the application of antioxidants in leukemia is still in the clinical trail stage.…”

“…As research continues to identify and describe the biomarkers of oxidative stress biology, it will be ultimately possible to determine an individual's susceptibility to oxidative stress and the treatment's impact on clinical outcomes and symptom severity [4] . The oxidative stress biomarkers make it possible to focus on the individualized treatment of diseases [60] . In the near future, targeted oxidative stress therapy combined with chemotherapy or other strategies may become a kind of useful clinical treatment for various blood diseases [61,62] .…”

Symptoms, Physical Activity, and Biomarkers in Children at the End of Leukemia Maintenance Therapy

“…Arachidonic acid is a polyunsaturated free fatty acid that occurs in high levels in membrane lipids (Hockenberry et al, 2014). F2-IsoP levels in the cerebrospinal fluid (CSF) have been shown to be associated with the symptom severity of a cluster of fatigue, pain, and nausea in children with ALL (Hockenberry et al, 2019). Other biomarkers of oxidative stress have been correlated with fatigue in children with cancer as well (Brown et al, 2021; Rodgers et al, 2016).…”