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

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

doi:10.7759/cureus.13208

Rabia Wali, Saadiya Javed Khan + Show 3 more

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https://doi.org/10.7759/cureus.13208

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Abstract

Background and objectiveIn low- and low-to-middle-income countries (LMICs), the incidence of treatment-related mortality (TRM) in patients with acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) is up to 52%. This study aimed to determine the mortality rate at the end of the induction phase of the treatment among patients with ALL and lymphoma at a tertiary care cancer center.MethodsThis retrospective study analyzed outcomes after induction chemotherapy in pediatric patients with acute leukemia and lymphoma at a tertiary care cancer center from January 2015 to December 2016. Information regarding demographics, clinical characteristics, and laboratory investigations were extracted and reviewed.ResultsOf the total 160 patients, 110 were males, and the mean age of the sample was 4.6 +2.8 years. B-cell leukemia (pre-B-ALL) was diagnosed in 84% (n=134), while 10% (n=6) had acute T-cell leukemia (pre-T-ALL) and 6% (n=10) had lymphoma. Sixteen patients (10%) died within the defined induction period, with 14 deaths occurring due to infections and two deaths resulting from chemotherapy-related toxicity.ConclusionBased on our findings, there is a significant prospect of mortality from infections during induction chemotherapy in patients with pediatric hematological malignancies.

Highlights

Acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) are among the most common hematological malignancies among pediatric patients and account for approximately 30% of all childhood cancers
Sixteen patients (10%) died within the defined induction period, with 14 deaths occurring due to infections and two deaths resulting from chemotherapy-related toxicity
We conducted a retrospective study on pediatric acute lymphoblastic leukemia (ALL) and LBL patients treated at the Shaukat Khanum Memorial Cancer Hospital (SKMCH) between January 2015 and December 2016

Summary

Introduction

Acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) are among the most common hematological malignancies among pediatric patients and account for approximately 30% of all childhood cancers. In the last 30 years, advances made in treatment have led to five-year survival rates of more than 80% [1] This has been accomplished through a better understanding of tumor biology at a molecular level, risk assignment, and intensification of chemotherapeutics based on a risk-adapted approach. Children may still experience extremely toxic drug-induced side effects, which can even result in treatment-related mortality (TRM). The majority of these reactions occur during the initial induction phase of the treatment [4]. In low- and low-to-middle-income countries (LMICs), the incidence of treatment-related mortality (TRM) in patients with acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) is up to 52%. This study aimed to determine the mortality rate at the end of the induction phase of the treatment among patients with ALL and lymphoma at a tertiary care cancer center

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