Assessment of Hematological Toxicity in Children with Acute Lymphoblastic Leukemia, Receiving Treatment with ALL IC-BFM 2009 Protocol

Abstract

The most common childhood cancer is acute lymphoblastic leukemia (ALL). Chemotherapy-associated hematological toxicity is well-known; however, there are few studies on hematologic toxicity incidence in children with ALL. We investigated the severity and incidence of hematologic toxicity during intense chemotherapy processes in children treated with ALL IC-BFM 2009 protocol. The study included 41 leukemic children in standard (SR) and intermediate risk (IR) groups treated between 2011 and 2015. During the induction period, the incidence of grade 4 toxicity in neutrophil count was 60%; the incidence of grade ≥ 3 toxicity in hemoglobin level was 34%; and the incidence of grade ≥ 3 toxicity in the platelet count was 51%. Deep neutropenia duration was 36.6 ± 12.7 (18-68) days during the induction. 53% of the febrile neutropenic (FEN) episodes developed during the induction period. There were no statistical differences between SR and IR risk groups with respect to hemogram values deep neutropenia duration and the number of FEN episodes (p > 0.05, all). There was a positive correlation between the number of FEN episodes and duration of neutropenia. During the induction, the mean neutrophil count remained between 0.5-1 × 109/L. FEN episodes most commonly developed during the induction phase.