Hematologic Recovery in Pediatric Patients with Acute Lymphoblastic Leukemia After Induction Chemotherapy

Abstract

Link of Video Abstract: https://youtu.be/ulLjSscae2Q Introduction: Myelosuppression in Acute Lymphoblastic Leukemia (ALL) children was associated with high morbidity and mortality. Chemotherapy was aimed to achieve remission conditions, including the elimination of blast cells in the bone marrow. However, the evidence of hematologic recovery after induction chemotherapy was poorly described. This study aimed to evaluate the profile of peripheral blood and the outcome of children with ALL after induction chemotherapy. Methods: A prospective study was conducted in the Hematology-Oncology Pediatric Department at Saiful Anwar Hospital Malang. Patients <15 years old who were newly diagnosed as ALL were enrolled in this study. Peripheral blood examinations were performed on the 1st, 2nd, 4th, and 6th weeks. Clinical outcomes were evaluated by remission status. Comparison and correlation analysis were done by IBM SPSS for Windows, version 26. P-value <0,05 was considered significant. Result: There were 27 children included in this study. The median age was 5 years. There were 15 males and 17 females, 18 patients with LLA-L2 and 9 patients with LLA-L1. All patients received chemotherapy regimens according to the 2018 National Protocol for ALL. The median hemoglobin level was significantly increased after induction chemotherapy (p< 0.05). Meanwhile, the reticulocyte count increased in the 2nd week after induction chemotherapy. The Absolute Neutrophil Count (ANC) significantly improved and reached the normal limit in 4th week after chemotherapy induction. The platelet count and Immature Platelet Fraction (IPF) also increased significantly (p< 0.05) and reached the normal limit in 4th week after induction of chemotherapy. Conclusion: Three cell lines regenerate at different rates at induction chemotherapy, with rapid erythrocyte recovery and slow neutrophil and platelet recovery.