Acute Leukemia Patients Research Articles

Utility of ursodiol prophylaxis against sinusoidal obstruction syndrome (SOS)/ veno-occlusive disease (VOD) in acute leukemia patients receiving gemtuzumab-ozogamicin (GO) or inotuzumab-ozogamicin (InO).

Sinusoidal obstructive syndrome (SOS)/veno-occlusive disease (VOD) is a serious complication in hematopoietic stem-cell transplant (HSCT) patients. Gemtuzumab-ozogamicin (GO) and InO are known to cause SOS/VOD in leukemic and transplant populations. Due to limited data on ursodiol prophylaxis in non-HSCT patients, we aimed to assess hepatotoxicity, SOS/VOD incidences, time to hepatotoxicity, and confirmed SOS/VOD in adults receiving GO or InO ± ursodiol. A multicenter, retrospective chart review of adult acute leukemia patients who received ≥1 dose of GO or InO at DFCI/some of the Harvard Cancer Centers during 4-year period (9/1/2017-9/1/2021). Acute promyelocytic leukemia patients and post-GO or InO HSCT-recipients (100-day follow-up period) were excluded. Descriptive summaries are provided, direct comparisons were made using Student T-test (continuous variables) and Fisher's exact test (categorical variables). In our population (N = 82), 87.8% received ursodiol and 12.2% did not. There were no significant differences in baseline to peak hepatic labs. The No-Ursodiol Group had higher incidence of Grade 3 aspartate aminotransferase (AST) transaminitis vs. the Ursodiol Group (60% vs. 20.8%; p = 0.015), and a trend towards shorter mean time to Grade 3 AST transaminitis (18.5 vs. 23.8 days; p = 0.30). Moreover, 4.2% of Ursodiol Group developed SOS/VOD vs. 0% in the No-Ursodiol Group (NS). Three patients developed SOS/VOD: 2 received GO, 1 received InO, and 2 were alive by the end of the follow-up period. In our cohort, ursodiol prophylaxis in adults receiving GO/InO is not associated with lower incidences of hepatotoxicity, SOS/VOD, or time to Grade 3 AST transaminitis, but is associated with decreased incidence of AST elevations.

Effects of oral Lcarnitine supplementation on liver enzymes in pediatric acute lymphoblastic leukemia patients in the maintenance phase of treatment: a randomized clinical trial study

Effects of oral Lcarnitine supplementation on liver enzymes in pediatric acute lymphoblastic leukemia patients in the maintenance phase of treatment: a randomized clinical trial study

The effects of bone marrow humoral components of B-cell acute lymphoblastic leukemia patients on natural killer cell suppression.

B-cell acute lymphoblastic leukemia (B-ALL) is the most common form of cancer diagnosed in children. While the majority of patients survive with conventional treatment, chemotherapeutic agents have adverse effects and the potential for relapse persists even after full recovery. Given their pivotal function in anti-cancer immunity, there has been a surge in research exploring the potential of natural killer (NK) cells in immunotherapy, which has emerged as a promising avenue for treating leukemia. Nevertheless, the efficacy of NK cell immunotherapy is less pronounced than expected, which suggests the external conditions that affect NK cell functions after the administration to patients with leukemia. In this study, the effects of humoral components in the bone marrow humoral components of B-ALL patients on healthy NK cells were investigated. Healthy peripheral blood mononuclear cells were cultured with and without bone marrow-derived plasma samples of B-ALL patients. The expression of PD-1 and IL-10 were found to be increased whereas the proliferative capacities of NK cells were found to be decreased at the presence of B-ALL plasma samples. Moreover, high IL-10 versus low IL-18 levels were detected in bone marrow plasma samples of B-ALL patients. These findings indicate that humoral components in the bone marrow of B-ALL patients exert a suppressive effect on NK cell functions.

Tyrosine kinase inhibitor discontinuation in non-allografted Philadelphia-positive acute lymphoblastic leukemia patients: a Campus ALL real-life study.

Not available.

Disseminated Intravascular Coagulation in Pediatric Acute Leukemia: Prevalence, Laboratory Features, and Prognostic Significance of ISTH Score.

Disseminated intravascular coagulation (DIC) is associated with acute leukemia. DIC prevalence and clinical consequences are complex and varies across acute leukemia subtypes. The International Society of Thrombosis and Hemostasis (ISTH) scoring system is used for the detection of overt DIC. Children of both sexes (1 day-18 years) with acute leukemia, suspected to have DIC and referred to hematology laboratory were included in the study. DIC score was calculated according to ISTH guidelines from laboratory values obtained within 24 h of admission and repeated after 2 weeks. The DIC cases were classified into overt DIC if ISTH score ≤ 5 and non-overt if ISTH score > 5. Sixty-two children diagnosed with acute leukemia and having the clinical and laboratory diagnostic features of DIC along with 48 age-matched healthy controls participated in the study. DIC was more frequently diagnosed in cases of AML (66.13%) compared to ALL (33.87%). Cases with T-ALL had DIC (19.4%) more frequently than B-ALL type (14.5%). Similarly, children with M5, M2, and M3 had DIC more frequently (16.1%, 15.58% and 14.28%, respectively) compared to other AML types. Overt DIC was observed in 71% of DIC cases with acute leukemia while non-overt DIC was diagnosed in 29% of them. Follow-up for 14 days of non-overt cases showed that 12 out of 18 patients progressed from non-overt to overt DIC with a significant increase in D-dimer and a decline in platelets count. The incidence of bleeding (35.4%) was higher than thrombosis (19.4%) among acute leukemia patients with DIC. An ISTH score ≤ 5 predicted increased intensive care unit (ICU) admission, death and end organ dysfunction with odds ratio of 4.28, 6.77, and 6.67, respectively. Based on receiver-operator analysis of DIC cases classified as overt and non-overt DIC based on ISTH score, D-Dimer was excellent predictor of overt DIC with the high sensitivity and specificity. ISTH score predicts death, ICU admission and organ dysfunction in children with acute leukemia. D-Dimer is an excellent predictor of overt DIC in acute leukemia.

Asciminib resistance of a new BCR::ABL1 p.I293_K294insSSLRD mutant detected in a Ph + ALL patient.

Chronic myeloid leukemia and Philadelphia chromosome-positive acute lymphoblastic leukemia patients largely benefit from an expanding tyrosine kinase inhibitors (TKIs) toolbox that has improved the outcome of both diseases. However, TKI success is continuously challenged by mutation-driven acquired resistance and therefore, close monitoring of clonal genetic diversity is necessary to ensure proper clinical management and adequate response to treatment. Here, we report the case of a ponatinib-resistant Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph + ALL) patient harboring a BCR::ABL1 p.I293_K294insSLLRD mutation. Using in vitro proliferation assays on newly generated Ba/F3 cell lines, we confirmed that the mutation confers moderate resistance to ponatinib, and to imatinib and nilotinib. In contrast, BCR::ABL1SLLRD Ba/F3 cells remain highly sensitive to dasatinib. Unexpectedly, the insertion also provides resistance to asciminib with no inhibitory effect up to 1000nM. Based on predicted structural models, we speculate that the p.I293_K294insSLLRD disrupts the interaction between the SH3 domain and the kinase domain, shifting the equilibrium toward the active conformation. This shift confers resistance to TKIs that preferentially bind to the inactive conformation, as well as to the allosteric asciminib inhibitor. However, the mutation retains sensitivity to dasatinib, which targets the active form of the kinase.

Predictive modeling of outcomes in acute leukemia patients undergoing allogeneic hematopoietic stem cell transplantation using machine learning techniques.

Leukemia necessitates continuous research for effective therapeutic techniques. Acute leukemia (AL) patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) focus on key outcomes such as overall survival (OS), relapse, and graft-versus-host disease (GVHD). This study aims to evaluate the capability of machine learning (ML) models in predicting OS, relapse, and GVHD in AL patients post-allo-HSCT. Clinical data from 1243 AL patients, with 10 years of follow-up, was utilized to develop 28 ML models. These models incorporated four feature selection methods and seven ML algorithms. Model performance was assessed using the concordance index (c-index) with multivariate analysis. The multivariate model analysis showed the best FS/ML combinations were UCI_GLMN, IBMA_GLMN and IBMA_CB for OS, UCI_ST, UCI_RSF, UCI GLMB, UCI_GB, UCI_CB, MI_GLMN, IBMA_ST and IBMA GB for relapse, IBMA_GB for aGVHD and Boruta_GB for cGVHD (all p values < 0.0001, mean C-indices in 0.61-0.68)). ML techniques, when combined with clinical variables, demonstrate high accuracy in predicting OS, relapse, and GVHD in AL patients.

DIFFERENTIAL IMPACT OF CD34+ CELL DOSE FOR DIFFERENT AGE GROUPS IN ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANTATION FOR ACUTE LEUKEMIA: A MACHINE LEARNING-BASED DISCOVERY

Allogeneic hematopoietic cell transplantation (allo-HCT) presents a potentially curative treatment for hematologic malignancies, yet carries associated risks and complications. Continuous research focuses on predicting outcomes and identifying risk factors. Notably, the influence of CD34+ cell dose on overall survival (OS) has been the subject of numerous studies yielding contradictory results. We developed machine learning (ML) models to predict allo-HCT outcomes and through the application of SHAP (SHapley Additive exPlanations), an explainable artificial intelligence (XAI) technique, enabled the identification of new and clinically relevant feature-outcome relationships. In particular, we identified clear interaction between CD34+ cell dose of peripheral blood stem cell (PBSC) grafts and patient age at allo-HCT for acute leukemia patients. Results of multivariable analysis validated the interaction effect: On young acute leukemia patients (≤45-year-old), low dose of CD34+ cells (<4.3 × 106 CD34+/kg) was associated with better OS against high dose (≥7 × 106 CD34+/kg) (hazard ratio [HR] 0.38, p=0.019), while for older acute leukemia patients (>45-year-old), low CD34+ cell dose (<3.8 × 106 CD34+/kg) was associated with worse OS against high dose (≥6.1 × 106 CD34+/kg) (HR 1.58, P = 0.033). In conclusion, our findings suggest that tailoring CD34+ cell dose by patient age may benefit acute leukemia patients undergoing allo-HCT, while XAI showcases excellent proficiency in revealing such interactions.

Drug-Induced Cauda Equina Syndrome in an 8-Year-Old Boy With Acute Lymphoblastic Leukemia: An Uncommon Case Report.

Intrathecal methotrexate can cause cauda equina syndrome in pediatric ALL patients, as demonstrated in this rare case of an 8-year-old boy. Symptoms included progressive limb weakness and urinary retention. Early recognition, prompt discontinuation of the offending agent, and multidisciplinary management are crucial. Vigilant neurological monitoring is essential for pediatric acute lymphoblastic leukemia patients receiving intrathecal chemotherapy.

Investigating the Effects of Nosocomial Clostridioides difficile Infection Among Acute Leukemia Patients: Insights From the 2020 National Inpatient Sample.

Rising nosocomial Clostridioides difficile infections pose high risks, especially for immunocompromised leukemia patients, necessitating targeted research to enhance patient care and outcomes.The objective of this study was to investigate the impact of nosocomial Clostridioides difficile infections (CDI) on patients hospitalized with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Our study was a retrospective analysis of adult patients hospitalized with a primary diagnosis of ALL or AML, using the Nationwide Inpatient Sample (NIS) database for 2020. Primary outcomes included the incidence of nosocomial CDI and all-cause inpatient mortality. Secondary outcomes included hospital length of stay, resource utilization, and morbidity. Statistical analyses were conducted with STATA (address). Fisher's exact test was utilized to compare proportions, while the Student's t test was employed for continuous variables. Multivariate logistic and linear regression analyses were used to adjust for confounding variables. We found in 21 135 ALL and 58 560 AML adult patients that the CDI incidences were 2.77% and 3.0%, respectively. ALL and AML patients with CDI had adjusted mortality odds ratios of 3.02 (P = .003) and 1.51 (P = .02). Hospital length of stay was extended by mean differences of 10.16 days (ALL) and 8.33 days (AML) for those with CDI compared to those without it. In addition, patients with CDI displayed a significantly higher incidence of acute kidney injury, sepsis, vasopressor use, and intensive care unit admissions. This study highlights the significant impact of CDI infections on health outcomes for leukemia patients, emphasizing the need for robust infection control measures, early detection, and aggressive management of CDI to improve patient outcomes and minimize healthcare costs.

Hypersensitive reactions to platelet transfusion: A case report of urticarial hives and pre-septal cellulitis in the context of a patient with Pre-B acute lymphoblastic leukaemia patient

Hypersensitive reactions to platelet transfusion: A case report of urticarial hives and pre-septal cellulitis in the context of a patient with Pre-B acute lymphoblastic leukaemia patient

Prognostic and therapeutic implications of measurable residual disease levels during remission induction of childhood ALL.

We evaluated the prognostic and therapeutic significance of measurable residual disease (MRD) during remission induction in pediatric acute lymphoblastic leukemia (ALL) patients. In the CCCG-ALL-2015 protocol, 7640 patients were categorized into low-, intermediate-, or high-risk groups based on clinical and genetic features. Final risk classification was determined by MRD assessed via flow cytometry on Days 19 and 46 of remission induction, with additional intensified chemotherapy for Day 19 MRD ≥1%. B-ALL patients with negative MRD (<0.01%) on Day 19 or Day 46 had significantly better 5-year event-free survival (EFS) than those with MRD 0.01-0.99%, who in turn had better EFS than patients with MRD ≥1%. Provisional low-risk patients with Day 19 MRD ≥1% but negative Day 46 MRD, reclassified as intermediate-risk, had comparable 5-year EFS to low-risk patients with Day 19 MRD 0.3-0.99% and negative Day 46 MRD (82.5% vs. 83.0%) and better EFS than provisional low-risk patients with MRD on both days (83.0% vs. 72.6%, P<0.001). Similarly, provisional intermediate-risk B-ALL patients with Day 19 MRD ≥1% but negative Day 46 MRD, who received additional therapy, had better 5-year EFS compared to those with Day 19 MRD between 0.3-0.99% (70.7% vs. 53.0%, P<0.001). Among low-risk patients with negative Day 46 MRD, those with negative Day 19 MRD had superior EFS compared to those with positive Day 19 MRD (91.7% vs. 86.1%, P<0.001). Optimal use of Day 19 MRD could improve individualized treatment and outcomes. Chinese Clinical Trial Registry (ChiCTR-IPR-14005706).

Ceftazidime-avibactam for the treatment of febrile neutropenia in HSCT recipients and acute leukemia patients post induction chemotherapy

Febrile neutropenia is a major complication in patients with acute leukemia or those undergoing hematopoietic stem cell transplantation (HSCT). Understanding patient characteristics and susceptibility patterns in febrile neutropenia is essential for appropriate antimicrobial therapy. First-line agents should have Pseudomonas aeruginosa coverage, but with the increase in multi-drug resistant organisms, ceftazidime-avibactam has emerged as a new therapeutic option. This retrospective case–control study included 300 admissions (143 patients) between January 2009 and December 2022. Patients with hematologic neoplasms and patients that underwent HSCT, satisfying the criteria of febrile neutropenia and treated with ceftazidime-avibactam (CAZAVI) were included and compared to controls who received the best available therapy (BAT). A bivariate regression model explored independent predictors of septic shock and mortality. Patients who received CAZAVI were more likely to have a microbiologically documented infection (59.0% vs. 28.3%). Complications were significantly more frequent in the CAZAVI group, with sepsis being the most common (59.0%). Multivariable logistic regression analysis showed that receiving CAZAVI was an independent risk factor for both sepsis and mortality (aOR 6.33 [95% CI 2.81–14.30] and 7.82 [2.63–23.26], respectively). Knowing common organisms and patterns of resistance, with an understanding of risk factors for morbidity and mortality, is crucial for the antimicrobial management of febrile neutropenia. Further studies on the effectiveness of CAZAVI in this population are needed.

Acute Leukemia Diagnosis Through AI-Enhanced Attenuated Total Reflection Fourier Transform Infrared Spectroscopy of Peripheral Blood Smears.

Acute leukemia, a highly perilous cancer, is diagnosed using invasive procedures like bone marrow aspirate and biopsy (BMA/BMB). This study investigated the use of artificial intelligence (AI)-enhanced Fourier transform infrared (FT-IR) spectroscopy as a non-invasive, reagent-free diagnostic alternative with high sensitivity and specificity. The spectral peak patterns of peripheral blood smears (PBS) from clinically healthy individuals (n = 50) BMA/BMB-confirmed acute leukemia patients (n = 50) were examined in the 1800-850 cm-1 range. Six trained models were used to assess the diagnostic performance, focusing on accuracy, positive predictive value (PPV), negative predictive value (NPV), F1 score, and area under the receiver operating characteristic (ROC) curve (AUC). The study shows significantly lower absorbance peaks in leukemia cases compared to healthy controls across various spectral regions: 1637.82, 1528.63, 1448.29, and 1388.54 cm-1, 1302.02, and 1240.21 cm-1, and 1163.99 cm-1. These differences indicate decreased concentrations or distinct molecular configurations of proteins, lipids, nucleic acids, and carbohydrates in cases. Conversely, they exhibited elevated absorbance peaks at 1032.14 and 894.11 cm-1 regions, suggesting potential disparities in amino acid, DNA, fatty acid, and saccharide residues compared to healthy controls. Of the six trained models, the SVM model demonstrated remarkable diagnostic performance, achieving an accuracy of 83%, a PPV of 80%, an NPV of 86%, an F1 score of 82.47%, and an AUC of 90.76%. This study demonstrates the potential of AI-enhanced FT-IR spectroscopy as a valuable adjunct diagnostic tool for acute leukemia. By offering a less invasive and faster alternative to BMA/BMB, this approach can potentially enhance leukemia diagnosis and improve patient outcomes, particularly in pediatric and geriatric cases.

The Gene Expression Levels of ETS2, ADAM28, and GPRC5D Genes in Acute Lymphoblastic Leukemia Patients

Background: Genetic biomarkers significantly influence the pathological differentiation and proliferation of lymphoid precursor cells, contributing to the development of Acute Lymphoblastic Leukemia (ALL) in children. This case-control study aimed to assess the expression levels of three potential biomarkers: ETS2, ADAM28, and GPRC5D, in patients with ALL. Materials and Methods: In this cross-sectional study, a group of ALL patients (n=65) referred to the hematology-oncology departments of Nemazee Hospital and Amir Hospital in Shiraz, Iran, from May 2018 to May 2021 were selected as the patient group. A control group (n=65) of age- and gender-matched volunteers was also selected. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) was used to study the expression profiles of these genes in patients and compare the results to those of a control group. The study included 65 patients with ALL and 65 healthy participants. The Pfaffl method of relative quantification, which compares the threshold cycle of a constitutive gene (TBP) with the test gene of each sample in duplicate, was used to determine the relative levels of ETS2, ADAM28, and GPRC5D gene expression. SPSS software version 16 was used for statistical analysis. Nonparametric tests were used to analyze non-normally distributed data, and the Mann-Whitney test was used to compare the medians and ranges and a p-value of 0.05 was considered significant. Results: The patient group showed significantly greater expression of the ETS2 and ADAM28 genes compared to the control group. (P &lt;0.0001; fold changes of 2.80 and 2.14, respectively), while GPRC5D expression remained unchanged (P &gt;0.05). Conclusion: These genetic biomarkers in patients with ALL may play an oncogenic role in the pathogenesis of the disease and could serve as potential novel biomarkers for ALL.

Clearing MRD positivity with blinatumomab in pediatric B-cell acute lymphoblastic leukemia: insights from droplet digital PCR and flow cytometry.

Blinatumomab has shown to improve survival outcomes in B-cell acute lymphoblastic leukemia (B-ALL) patients with measurable residual disease (MRD) detected by multiparametric flow cytometry (MFC). However, data on blinatumomab clearing MRD with high sensitivity remain scarce. This study evaluates the effectiveness of blinatumomab in eradicating low levels of MRD, as detected by droplet digital PCR (ddPCR) but undetectable by MFC, in children with B-ALL. Patients (n = 9) whose MRD was undetectable by MFC but detectable by ddPCR after chemotherapy and followed by blinatumomab consolidation were included retrospectively. After the administration of blinatumomab, 5 out of 9 patients (55.56%) successfully achieved undetectable levels of ddPCR-MRD. Notably, among the 4 patients with BCR::ABL1 gene-positive acute lymphoblastic leukemia (ALL), only one achieved gene negativity. Starting from the initiation of blinatumomab treatment, with a median follow-up of 12 months, all patients remained in complete remission. Our study was the first to demonstrate that blinatumomab could further eradicate ddPCR MRD after patients achieve MFC-MRD undetectable status in B-ALL patients.

Five-year outcomes of CD19 followed by CD22 chimeric antigen receptor T-cell therapy in B-cell acute lymphoblastic leukemia patients who relapsed after allo-transplantation.

Not available.

Damage of the Bone Marrow Stromal Precursors in Patients with Acute Leukemia at the Onset of the Disease and During Treatment.

In patients with acute leukemia (AL), malignant cells and therapy modify the properties of multipotent mesenchymal stromal cells (MSCs) and their descendants, reducing their ability to maintain normal hematopoiesis. The aim of this work was to elucidate the alterations in MSCs at the onset and after therapy in patients with AL. The study included MSCs obtained from the bone marrow of 78 AL patients (42 AML and 36 ALL) and healthy donors. MSC growth characteristics, gene expression pattern, proteome and secretome were studied using appropriate methods. The concentration of MSCs in the bone marrow, proliferative potential, the expression of several genes, proteomes and secretomes were altered in AL-MSCs. Stromal progenitors had been affected differently in ALL and AML patients. In remission, MSC functions remain impaired despite the absence of tumor cells and the maintenance of benign hematopoietic cells. AL causes crucial and, to a large extent, irreversible changes in bone marrow MSCs.

Relationship of Serum Uric Acid and Serum Creatinine Levels with Total Count of WBC in Acute Leukaemia

Background: Leukaemia is uncontrolled proliferation of white blood cells caused by mutation of myelogenous or lymphogenous cells which are usually characterized by increased number of white blood cells in the blood. Leukaemia accounts for about four percent of all death from malignant disease. The incidence of acute leukaemia is about 10 per lac per year. Acute leukaemia can occur at any age. The cause of leukaemia is unknown in most patients. Serum uric acid and creatinine levels increased and positively correlated with total count of WBC in acute leukaemic patients. Objective: Objective of our study is to observe the relationship of serum uric acid and creatinine levels with total count of WBC in pre-chemotherapy stage of acute leukaemic patients. Method: Total 60 of acute leukaemia patients were included in this study. Among them, 30 patients’ WBC count were below 50,000/cmm and 30 patients’ WBC count were above 50,000/cmm. Result: Majority patients were male. Serum uric acid and creatinine levels were significantly higher in acute leukaemic patients with WBC count above 50,000/cu mm of blood than those with total count of WBC below 50,000/cmm.

Predictors of breakthrough invasive fungal infections (BIFI) in pediatric acute leukemia: a retrospective analysis and predictive model development

ObjectiveThis study aims to identify key risk factors associated with the development of breakthrough invasive fungal infections (BIFI) in pediatric acute leukemia patients to improve early detection and intervention strategies.MethodA retrospective analysis was conducted on 160 pediatric patients with acute leukemia admitted to Anhui Provincial Children's Hospital between October 2018 and June 2022. The study evaluated the impact of various clinical parameters on BIFI risk using univariate and multivariable analyses, with data including patient demographics, treatment regimens, and infection outcomes. The predictive model was assessed using receiver operating characteristic (ROC) curve analysis, calibration plots, and decision curve analysis (DCA).ResultAmong the 160 pediatric acute leukemia patients, 34 (22.22%) developed BIFI. Univariate analysis identified longer durations of neutrophil deficiency (P &amp;lt; 0.001), broad-spectrum antibiotic use (P &amp;lt; 0.001), higher volumes of red blood cell transfusions (P = 0.001), and elevated C-reactive protein (CRP) levels (P &amp;lt; 0.001) as significant factors associated with BIFI. Multivariable analysis confirmed these as significant predictors, with odds ratios for neutrophil deficiency (OR = 1.38, 95% CI [1.15, 1.69]), antibiotic use (OR = 1.41, 95% CI [1.10, 1.84]), transfusions (OR = 2.54, 95% CI [1.39, 5.13]), and CRP levels (OR = 1.10, 95% CI [1.04, 1.17]). The model validation showed strong predictive performance with an AUC of 0.890 (95% CI: 0.828–0.952), good calibration (Brier score = 0.099), and demonstrated clinical utility across a range of risk thresholds.ConclusionThe study highlights the importance of considering these key predictors in the management of pediatric acute leukemia patients to mitigate the risk of BIFI. Incorporating these factors into personalized treatment strategies could enhance early intervention, reduce infection rates, and improve overall patient outcomes.