Complications of Induction of Remission Chemotherapy in Childhood Acute Lymphoblastic Leukemia
Tasnuva Khan *
Department of Pediatrics, Upazila Health Complex, Sreenagar, Munshiganj, Bangladesh.
Salwa Khan
Department of Neuro-Ophthalmology, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh.
Mehnaz Akter
Department of Paediatric Haematology and Oncology, National Institute of Cancer Research and Hospital, Dhaka, Bangladesh.
Safinaz Khan
Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Habiba Khatun
Paediatrics Outdoor, Dhaka Medical College Hospital, Dhaka, Bangladesh.
Bithi Rani Shaha
Department of Pediatrics, Upazila Health Complex, Bholahat, Chapainawabganj, Bangladesh.
Joyashree Chakraborty
Department of Pediatrics, Gopalganj Sadar Hospital, Gopalganj, Bangladesh.
*Author to whom correspondence should be addressed.
Abstract
Background: Acute lymphoblastic leukemia is the most common malignancy in children. Myelosuppression and immunosuppressions are anticipated complications of leukemia and chemotherapy, making patients liable to complications and these patients require close monitoring. Awareness of complication patterns and prompt management may reduce treatment failure and death. This study aims to determine childhood acute lymphoblastic leukemia outcomes during induction of remission chemotherapy.
Methods: This cross sectional study was conducted at the Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), from January 2013 to June 2013. Total 50 cases of acute lymphoblastic leukemia, aged 1 to 15 years, received induction of remission chemotherapy were included in this study. Complications were recorded during induction chemotherapy, along with remission rates and duration required to complete the induction schedule.
Results: The mean age of presentation with ALL was 6.2±3.2 years with 56.0% male patients. During induction chemotherapy, 54.0% patients had febrile neutropenia, 48.0% had gastrointestinal complications, 46.0% had respiratory complications, 28.0% had haemorrhage and 12.0% had tumor lysis syndrome. Mortality rate was 12.0%. Three patients died from pneumonia, two from haemorrhage and one from pneumonia. 72.0% patients completed induction remission chemotherapy, 16.0% abandoned chemotherapy and 12.0% expired during chemotherapy.
Conclusion:Induction chemotherapy was often associated with febrile neutropenia, gastrointestinal and respiratory complications as well as hemorrhage. The adherence in childhood acute lymphoblastic leukemia can be improved by enhanced supportive care, infection control and timely interventions.
Keywords: Acute lymphoblastic leukemia, Induction chemotherapy, complications, Febrile neutropenia