Long-Term and Quality of Survival in Patients Treated for Acute Lymphoblastic Leukemia during the Pediatric Age

Devilli, Lara; Garonzi, Chiara; Balter, Rita; Bonetti, Elisa; Chinello, Matteo; Zaccaron, Ada; Vitale, Virginia; Bortoli, Massimiliano De; Caddeo, Giulia; Baretta, Valentina; Tridello, Gloria; Cesaro, Simone

doi:10.4081/hr.2021.8847

Cited by 4 publications

(6 citation statements)

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“…The development of effective treatments and well‐designed clinical protocols have resulted in a dramatic increase of the long‐term outcome of ALL over the last few decades, with overall survival rates exceeding 90%, and without compromising the quality of life of survivors. 21 , 22 The bacterial‐derived enzymes, asparaginases, are among the drugs used in the treatment of ALL, with E. coli asparaginase, a pegylated form of the native E. coli asparaginase, and an enzyme isolated from Erwinia as the three main types. Other novel forms of recombinant E. coli asparaginase 23 and a pegylated recombinant formulation of Erwinia asparaginase 24 have been recently developed and are currently under investigation.…”

Section: Discussionmentioning

confidence: 99%

Asparaginase activity monitoring in pediatric acute lymphoblastic leukemia: A cross‐sectional nationwide study in Spain

Lassaletta

Gutiérrez

2022

Cancer Reports

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Background: A cross-sectional nationwide study was designed to assess national compliance with international consensus/guidelines of monitoring asparaginase levels in children with acute lymphoblastic leukemia (ALL) treated with asparaginase in routine clinical practice.Methods: An ad hoc questionnaire was designed and completed by staff physicians from Hemato-Oncology Units throughout Spain.Results: A total of 39 physicians (64% pediatricians) with a mean (SD) age 43.5 (7.9) years and 15.3 (17.6) years of professional activity participated in the study. They accounted for 90% of hospitals in which children with ALL are treated in Spain. A total of 19 participants (48.7%) reported that asparaginase levels were routinely monitored (own center in 2 cases [10.5%], another hospital in 17 cases [89.5%]). Asparaginase was not monitored in 51.3% of the cases, mostly (80%) because unavailability of testing. When asparaginase was monitored, 68% of participants reported that this was done in all asparaginase-treated patients and 84% in all phases of the disease (induction, consolidation, re-induction, maintenance) with a time interval of 7 days for the pegylated form, 48 h for Erwinia asparaginase and 14 days for maintenance with the pegylated form. All participants reported that they modified treatment according to results of testing, with a limit of total depletion of ≥100 IU/L. Levels <100 or 20 IU/L were considered indicative of hypersensitivity by 46% of physicians. Conclusion:There is still a gap between what is recommended and what is done in clinical practice, with more than 50% of centers not monitoring the level of asparaginase activity in pediatric ALL. Protocols for asparaginase testing in daily practice should be implemented.

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Section: Discussionmentioning

confidence: 99%

Asparaginase activity monitoring in pediatric acute lymphoblastic leukemia: A cross‐sectional nationwide study in Spain

Lassaletta

Gutiérrez

2022

Cancer Reports

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“…The data were obtained from medical records of all childhood ALL patients presenting with hyperleukocytosis to our facility and who underwent exchange transfusion within the time frame specified. The inclusion criteria were ALL patients aged 0-19 years with leukocyte counts above 100x10 9 /L, treated with exchange transfusion, and complete medical records of the pre-and post-therapy clinical and laboratory data. The exclusion criteria was medical records that lacked data outcomes., death before the exchange This study was approved by the Ethics Committee of the Faculty of Medicine, Universitas Airlangga.…”

Section: Methodsmentioning

confidence: 99%

“…Studies have shown improved 5-year overall survival rates exceeding 90%, and the current treatment is considered to be well-tolerated and does not impair survivors' quality of life. 8,9 Even with such significantly satisfactory outcomes, complications and emergencies in ALL still require immense consideration. Hyperleukocytosis, reported in 9-13% of children with ALL, is one of the complications and a risk factor for early morbidity and mortality, as well as poor outcomes.…”

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confidence: 99%

“…Hyperleukocytosis, reported in 9-13% of children with ALL, is one of the complications and a risk factor for early morbidity and mortality, as well as poor outcomes. 10,11 Hyperleukocytosis has an event-free survival rate as low as 63.3%, vs. 100% in patients with a white blood cell (WBC) count below 100x10 9 /L. [11][12][13] Patients who initially present with hyperleukocytosis are also at risk of developing early problems, resulting in a 20% death rate during remission induction treatment.…”

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confidence: 99%

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Clinical and laboratory effects of exchange transfusion in pediatric acute lymphoblastic leukemia with hyperleukocytosis

Lazuwardi,

Andarsini,

Hernaningsih

2023

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Background Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. Emergency complications such as hyperleukocytosis can arise as the disease develops. Exchange transfusion is one of many cytoreductive modalities to resolve the condition. Objective To analyze the clinical and laboratory effects of exchange transfusion in childhood acute lymphoblastic leukemia patients with hyperleukocytosis. Methods This analytical retrospective cohort study with a pre- and post-test design used secondary medical record data. The obtained characteristics were the incidences of dyspnea, tachypnea, headache, intracranial bleeding, hepatomegaly, splenomegaly, lymphadenopathy, abdominal pain, fever, pallor, nausea/vomiting, and skin or mucosal bleeding; hemoglobin, white blood cell, and platelet counts; and serum potassium, sodium, calcium, phosphate, blood urea nitrogen, and creatinine levels. Results A total of 16 patients underwent exchange transfusion; they had significant reductions of the incidence of dyspnea, tachypnea, hepatomegaly, and pallor and significant improvement in the form of elevation of hemoglobin level and decrease in white blood cell counts (P<0.05 for all) compared to pre-treatment. The remainder of the variables were not significantly different between pre- and post-treatment, but a general decrease in all clinical manifestations except intracranial bleeding was observed. Conclusion Exchange transfusion has the beneficial effect of resolving hyperleukocytosis and its manifestations, although correction in laboratory outcomes that remained abnormal are still needed.

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“…T-cell precursor acute lymphoblastic leukemia (T-ALL) represents approximately 10% of all pediatric cases (2)(3)(4)(5)(6). Despite progress made through innovative therapies and treatment regimens, achieving disease-free survival rates of 90% in developed countries, hematological malignancies in children persist as the leading cause of disease-related deaths globally (1,7).…”

Section: Introductionmentioning

confidence: 99%

Implementation of a roadmap for the comprehensive diagnosis, follow-up, and research of childhood leukemias in vulnerable regions of Mexico: results from the PRONAII Strategy

Núñez-Enríquez,

Romo-Rodríguez,

Gaspar-Mendoza

et al. 2024

Front. Oncol.

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The main objective of the National Project for Research and Incidence of Childhood Leukemias is to reduce early mortality rates for these neoplasms in the vulnerable regions of Mexico. This project was conducted in the states of Oaxaca, Puebla, and Tlaxcala. A key strategy of the project is the implementation of an effective roadmap to ensure that leukemia patients are the target of maximum benefit of interdisciplinary collaboration between researchers, clinicians, surveyors, and laboratories. This strategy guarantees the comprehensive management of diagnosis and follow-up samples of pediatric patients with leukemia, centralizing, managing, and analyzing the information collected. Additionally, it allows for a precise diagnosis and monitoring of the disease through immunophenotype and measurable residual disease (MRD) studies, enhancing research and supporting informed clinical decisions for the first time in these regions through a population-based study. This initiative has significantly improved the diagnostic capacity of leukemia in girls, boys, and adolescents in the regions of Oaxaca, Puebla, and Tlaxcala, providing comprehensive, high-quality care with full coverage in the region. Likewise, it has strengthened collaboration between health institutions, researchers, and professionals in the sector, which contributes to reducing the impact of the disease on the community.

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Long-Term and Quality of Survival in Patients Treated for Acute Lymphoblastic Leukemia during the Pediatric Age

Cited by 4 publications

References 20 publications

Asparaginase activity monitoring in pediatric acute lymphoblastic leukemia: A cross‐sectional nationwide study in Spain

Asparaginase activity monitoring in pediatric acute lymphoblastic leukemia: A cross‐sectional nationwide study in Spain

Clinical and laboratory effects of exchange transfusion in pediatric acute lymphoblastic leukemia with hyperleukocytosis

Implementation of a roadmap for the comprehensive diagnosis, follow-up, and research of childhood leukemias in vulnerable regions of Mexico: results from the PRONAII Strategy

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