Intensive Phase Of Chemotherapy Research Articles

Inhalation Surfactant Therapy within Comprehensive Treatment of HIV-Infected Patients with Multiple Drug Resistant Tuberculosis

The objective: to evaluate the main eff ects of surfactant inhalations during the intensive phase of chemotherapy with the regimen containing bedaquiline and linezolid in HIV-infected patients with multiple drug resistant tuberculosis.Subjects and Methods. A single-center, open-label, controlled prospective cohort study was conducted. 80 patients with MDR-TB/HIV were enrolled in the study and randomized into two groups: ST+ Group included 40 patients who in addition to anti-tuberculosis therapy containing bedaquiline and linezolid during the intensive phase received inhalation of the suspension of Surfactant-BL according to a certain regimen. The course of 28 inhalations took 2 months, the total dose of surfactant was 700 mg. ST- Group included 40 patients who received anti-tuberculosis therapy only. To assess the severity of respiratory symptoms in patients, we used our own scoring. All patients also received antiretroviral therapy.Results. In the ST+ Group versus ST- Group, there was a decrease in the severity of tuberculosis clinical manifestations and timing of their relief, higher frequency of cavity healing by 21.2%, and faster sputum conversion by 28.6%. These rates are higher than in ST- Group and this is a short period of 10 weeks. None of the patients developed adverse reactions to surfactant inhalations. Patients tolerated well the combination of surfactant therapy, MDR TB chemotherapy containing bedaquiline and linezolid, and ART.

Outcome of neutropenic enteropathy during induction phase of treatment of childhood acute lymphoblastic leukemia

BackgroundNeutropenic enteropathy is one of the important causes of death during intensive phase of chemotherapy in children with acute lymphoblastic leukemia (ALL). It follows a prolonged course of neutropenia and carries a mortality rate up to 30%. The study aimed to find out the outcomes of typhlitis during induction phase of treatment of childhood ALL. Material and methodsThis prospective case control study was conducted in the Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from November 2018 to January 2021. Children (<19 years) with ALL who developed neutropenic enteropathy during induction phase of chemotherapy without any comorbid condition were included in this study. The clinico-radiological diagnosis of neutropenic enteropathy was based on a standard diagnostic criteria. Complete blood count, serum electrolytes, albumin, blood culture, stool culture, abdominal X-ray and ultrasonogram were performed in all the cases. ResultsThirty-six patients developed neutropenic enteropathy. 8 (22.2%) died. Thrombocytopenia (p = 0.001), hypoalbuminemia (Odd ratio 21.0, p < 0.001), positive blood culture (Odds ratio 6.11, p = 0.026). ConclusionThis study found a mortality rate of 22.2% amongst the pediatric patients with ALL who developed neutropenic enteropathy during induction chemotherapy. Thrombocytopenia, hypoalbuminemia, and a positive blood culture predicted mortality.

Integrative medicine during the intensive phase of chemotherapy in pediatric oncology in Germany: a randomized controlled trial with 5-year follow up

BackgroundIntegrative medicine is used frequently alongside chemotherapy treatment in pediatric oncology, but little is known about the influence on toxicity. This German, multi-center, open-label, randomized controlled trial assessed the effects of complementary treatments on toxicity related to intensive-phase chemotherapy treatment in children aged 1–18 with the primary outcome of the toxicity sum score. Secondary outcomes were chemotherapy-related toxicity, overall and event-free survival after 5 years in study patients.MethodsIntervention and control were given standard chemotherapy according to malignancy & tumor type. The intervention arm was provided with anthroposophic supportive treatment (AST); given as anthroposophic base medication (AMP), as a base medication for all patients and additional on-demand treatment tailored to the intervention malignancy groups. The control was given no AMP. The toxicity sum score (TSS) was assessed using NCI-CTC scales.ResultsData of 288 patients could be analyzed. Analysis did not reveal any statistically significant differences between the AST and the control group for the primary endpoint or the toxicity measures (secondary endpoints). Furthermore, groups did not differ significantly in the five-year overall and event-free survival follow up.DiscussionIn this trial findings showed that AST was able to be safely administered in a clinical setting, although no beneficial effects of AST between group toxicity scores, overall or event-free survival were shown.

How essential are in-person clinic visits during maintenance treatment of children with acute lymphoblastic leukemia?

Acute lymphoblastic leukemia (ALL) is the most common cancer in children. Treatment consists of an initial intensive phase of chemotherapy, followed by a prolonged period of maintenance chemotherapy intended to reduce the risk of relapse. During the COVID-19 pandemic, the need arose to identify and reduce non-essential hospital visits. We aimed to determine which proportion of in-person clinic visits during ALL maintenance therapy was associated with a change of management based on the results of the physical examination. Medical records of children receiving maintenance chemotherapy for B-precursor ALL between September 2019 and February 2020 were reviewed. Visits with a new finding on physical examination were divided into those where an in-person assessment was deemed essential versus not essential. Finally, we determined the proportion of essential in-person visits that resulted in a change of management. A total of 240 maintenance visits by 75 children were analyzed. An abnormal finding on physical examination was noted during 20 visits (8.3%). Of those, 14 (5.8%) uncovered a new finding, six (2.5%) were classified as "in-person visit essential," and among those six visits, three (1.2%) resulted in a change of patient management (one for acute otitis media, one for wheezing, and one for limp). Our findings support the evaluation of care delivery models other than in-person visits during ALL maintenance therapy. A prospective study is required to delineate criteria, benefits/risks, and families' perspectives associated with virtual care delivery and the optimal frequency of in-person visits.

Влияние селена на функцию щитовидной железы и эффективность химиотерапии у больных туберкулезом с сопутствующим сахарным диабетом и аутоиммунным тиреоидитом

У 40 больных туберкулезом легких и сахарным диабетом проведено ультразвуковое исследование эхоструктуры щитовидной железы и в сыворотке крови иммуноферментным методом определены уровни содержания свободного тироксина, тиреотропного гормона гипофиза, антител к тиреоглобулину и тиреопероксидазе и уровень селена до начала и в конце интенсивной фазы химиотерапии в зависимости от назначения селенита натрия. Эффективность противотуберкулезной химиотерапии оценивалась по общепринятым клиническим, бактериологическим и рентгенологическим критериям. Аутоиммунный тиреоидит с явлениями субклинического гипотиреоза диагностирован у всех обследованных лиц. Применение селенита натрия на протяжении фазы интенсивной химиотерапии восстанавливало функцию щитовидной железы. Темпы исчезновения симптомов интоксикации, абациллирования мокроты и заживления деструкций в конце фазы интенсивной химиотерапии достоверно выше в группе больных с назначением селенита натрия.

Influence of compensation of selenium deficiency on immunological parameters of patients with multidrugresistant tuberculosis at the background of subclinical hypothyroidism

In 60 patients with multidrug-resistant tuberculosis at the background of subclinical hypothyroidism serum level of selenium, thyroid state and immunological parameters were studied in dynamic of the intensive phase of chemotherapy. Initially low level of selenium, subclinical hypothyroidism and weaken immunological response toward tuberculosis were diagnosed. Prescribing of selenite sodium with 200 μ daily during 60 daily doses normalized serum level of selenium, restored thyroid function and improved immunological response. Using of selenite sodium like an accompanying medicine during chemotherapy of multidrug tuberculosis at the background of subclinical hypothyroidism after estimation of serum level of selenium is recommended.

Retrospective Analysis of Bacterial Isolates during Blood Stream Infections in Children with Chemotherapy-induced Febrile Neutropenia: A Single Centre Experience

Abstract Introduction The recent advances in cancer treatment have resulted in significant improvement in the outcome of pediatric cancers. However, febrile neutropenia (FN) is the most important cause of mortality and morbidity in pediatric cancer patients and is a crucial limiting factor for the outcome. The greatest threat that we are facing is the emergence of pan drug-resistant (PDR) organisms. Objectives To study bacterial organisms causing bloodstream infections (BSI) during febrile neutropenia episodes, their antibiotic sensitivity pattern, impact on treatment outcome during the intensive phase of chemotherapy, and the association between prior administration of antibiotics and emergence of multidrug-resistant organisms (MDR). Materials and Methods This retrospective study was conducted in patients between the age group of 0 to 18 years who were treated for malignancies in the division of pediatric oncology at a tertiary center from August 2017 to December 2020. Blood cultures were collected under aseptic precautions, and they were processed as per the Clinical and Laboratory Standard Institute Guideline (CLSI) 2017. Results A total of 122/159 (76.7%) patients were diagnosed to have hematological malignancies, and 37/159 (23.3%) patients were found to be suffering from solid tumors. A total of 309 episodes of FN were documented and 386 cultures were sent, out of which 87/386 (22.53%) cultures were positive for bacteria and 2/386 (2.2%) for fungi. Gram-negative isolates were seen in 51/87 (58.62%) cultures and Gram-positive in 36/87 (41.37%) cultures. Burkholderia cepacia and coagulase-negative Staphylococci (CONS) were the commonest found Gram-negative and Gram-positive bacteria, respectively. MDR bacterial strains were seen in 44/87 (50.57%) cultures and PDR strains in 8/87 (9.2%) cultures. Resistance was higher with Klebsiella species and CONS. There were six mortalities during the induction phase of acute leukemia treatment, out of which 4/6 (66.66%) were due to MDR infections, 1/6 (16.6%) due to fungal infection and chemotherapy refractoriness each. Conclusion Proven bacterial infections were determined in 22.53% of febrile neutropenia episodes. Most BSI in patients with febrile neutropenia were caused by Gram-negative bacteria. Indiscriminate use of higher antibiotics before referral led to the emergence of MDR organisms, thus compromising the outcome. Our study emphasizes the fact that antibiotic stewardship is a crucial task to counter MDR bacteremia-related morbidity and mortality in neutropenic children.

Analysis of treatment outcomes for destructive pulmonary tuberculosis in patients with multiple drug resistance of M. tuberculosis

The objective of the study: to analyze treatment outcomes in patients with pulmonary destructive MDR tuberculosis who completed the intensive phase of treatment and had healed or persisting cavities.Subjects and methods. Treatment outcomes were retrospectively analyzed in 191 patients suffering from destructive pulmonary MDR tuberculosis who underwent the intensive phase of chemotherapy in in-patient settings in 2009-2012 and 2013-2015 (treated by different regime ns); in each of those cohorts, groups were formed depending on persistence/healing of destruction (cavities) during the intensive phase of chemotherapy: (CV-) ‒ the destruction healed, (CV+) – the destruction persisted.Results. In 24 months, treatment was found to be effective only in 19/68 (27.9%) in the (CV+) group versus 31/40 (77.5%) in the (CV-) group, p &lt; 0.05 (cohort 2009-2012); 17/42 (40.5%) versus 29/41 (70.7%), respectively, p &lt; 0.05 (2013-2015 cohort). Within 48 months, treatment outcomes were as follows: clinical cure in the (CV+) group was 38.2% (26/68 people), and in the (CV-) group – 72.7% (29/40 people), p &lt; 0.05 (2009- 2012) and 23/42 (54.7%) and 33/41 (80.5%), respectively, p &lt; 0.05 (2013-2015 cohort).Conclusion. Considering the above, when assessing treatment in the intensive phase of chemotherapy in destructive pulmonary tuberculosis patients, it is necessary to take into account the rate of cavity healing but not being limited to sputum conversion. Patients with persisting cavities should not be transferred to the continuation phase, the surgery or collapse treatment should be considered for such patients.

Results of treatment with bedaquiline containing regimens of MDR/XDR tuberculosis patients including those with concurrent HIV infection (the experience of Leningrad Region)

The effectiveness of tuberculosis control is associated with efficacy of treatment of TB patients and above all patients with multiple and extensive drug resistance (MDR/XDR MTB). Patients with TB/HIV co-infection providethe significant impact on the situation.The objective of the studyis to assess outcomes of chemotherapy regimens containing bedaquiline in patients with MDR/XDR TB including those with concurrent HIV infection.Subjects and methods. The efficacy and safety of the regimes containing bedaquiline were assessed in the intensive phase of chemotherapy in 80 patients with MDR/XDR TB: Group1 consisted of 46 patients with negative HIV status (ICD10 code A15-A19); Group 2 – 34 HIV positive patients at the advanced stage with manifestations of a mycobacterial infection (ICD10 code B20.0).Results. Treatment outcomes in the groups were as follows: the effective treatment was statistically significantly more frequent in Group 1 versus Group 2 (80.4 and 52.9%, respectively, p = 0.0088). Treatment failure was registered in 3 patients from each group; treatment defaults were statistically significantly more frequent in Group 2 compared to Group 1: in 8/34 versus 2/46 (p = 0.011). 3 patients were transferred out in both Group 1 and Group 2 (3/46 and 3/34, p = 0.69). During treatment, only 1 patient from Group 2 developed an adverse event, most likely associated with the in-take of bedaquiline, a heart rhythm disorder (ventricular arrhythmia) and prolongation of QTcF &gt; 450 ms.

Features of infusion chemotherapy with first-line drugs in patients with tuberculous meningitis and HIV

Objective. To investigate the effectiveness of first-line intravenous drugs (isoniazid and ethambutol) in patients with tuberculous meningitis and HIV during the intensive phase of chemotherapy.&#x0D; Materials and methods. 54 patients with newly diagnosed infiltrative pulmonary tuberculosis, tuberculous meningitis, and HIV were included in this study. The presence of Mycobacterium tuberculosis in sputum was observed in all patients. Group 1 consisted of 23 patients receiving ethambutol and isoniazid intravenously, and rifampicin and pyrazinamide were administered orally. Group 2 consisted of 31 patients treated with first-line oral anti-tuberculosis drugs. Serum isoniazid and ethambutol concentrations were determined by chromatographic method.&#x0D; Results. There was a greater improvement in clinical symptoms and radiographic evidence in patients receiving intravenous isoniazid and ethambutol compared with group 2. Positivity of sputum Mycobacterium tuberculosis was observed during the second month of treatment in 25.0 % of patients in group 1 and 76.1 % of patients in the control group (p=0.003). In addition, 9 (39.1 %) patients died before 6 months when isoniazid and ethambutol were administered intravenously compared with 22 (70.9 %) in group 2 (p=0.023).&#x0D; Conclusions. In tuberculous meningitis and HIV, intravenous treatment with isoniazid and ethambutol was more effective than oral treatment for 2 months of intensive treatment in the form of faster sputum conversion, clinical improvement, and higher mean concentrations of isoniazid and ethambut blood. In addition, mortality was lower with intravenous isoniazid and ethambutol compared with oral treatment.

Reparation of lung tissue in newly detected pulmonary tuberculosis as genetically determined process

The objective of the study is to assess the effect of rs6707530 polymorphism of the FN1 gene and rs1150754 polymorphism of the TNXB gene on the healing of lung tissue destruction in patients with newly detected pulmonary tuberculosis.Subjects and methods. 82 patients older 18 years with newly diagnosed pulmonary tuberculosis with destruction were enrolled in the study. X-ray data were assessed on the 2nd, 4th and 6th months of the study. Patients were divided into 2 groups depending on the efficacy of chemotherapy intensive phase.Results. In the group of patients with an effective course of chemotherapy, the frequency of carriers of G allele (p &lt; 0.001) and T/G genotype (p = 0.01) in rs6707530 locus of the FN1 gene was higher. While T/T genotype (p = 0.002) and T allele (p &lt; 0.001) prevailed among the patients with persisting destruction of lung tissue after the intensive phase of chemotherapy.

ОБОСНОВАНИЕ КОНЦЕПЦИИ ХИМИОТЕРАПИИ ТУБЕРКУЛЕЗА ОРГАНОВ ДЫХАНИЯ У ДЕТЕЙ И ПОДРОСТКОВ

The article presents the review of publications devoted to personalized tuberculosis chemotherapy in children and adolescents with consideration of the specific course of the disease with the relevance to age. It is possible to reduce the duration of chemotherapy and the number of anti-tuberculosis drugs within the regimen. At the same time, the major criteria include results of microbiological tests of diagnostic specimens of the patient’s and/or index case and drug susceptibility tests in full both by express and traditional microbiological methods, microbiological and radiological monitoring, primarily in the intensive phase of chemotherapy. Generally, this personalized approach can assure high treatment efficacy.

ВЛИЯНИЕ ГЛИЦИРРИЗИНОВОЙ КИСЛОТЫ НА СОСТОЯНИЕ МЕМБРАННЫХ СТРУКТУР МОНОНУКЛЕАРОВ У БОЛЬНЫХ ТУБЕРКУЛЕЗОМ ЛЕГКИХ НА ФОНЕ ПРОТИВОТУБЕРКУЛЕЗНОЙ ХИМИОТЕРАПИИ

The objective of the study : to assess the lipid profile of membranes of peripheral blood mononuclear cells in the pulmonary tuberculosis patients before and after the intensive phase of chemotherapy, including the effect of glycyrrhizic acid. Subjects and methods . 384 pulmonary tuberculosis patients of both genders in the age from 25 to 60 years old were enrolled into the study: 308 patients were treated by regimen I during the intensive phase of chemotherapy, and 76 had the intensive phase with regimen I and glycyrrhizic acid. The control group included 36 healthy volunteers at the age from 24 to 58 years old. The lipid profile of mononuclear cell membranes was evaluated in peripheral blood of the patients. Phospholipids were fractioned into classes using continuous-flow thin-layer chromatography. The following fractions were studied: total lysophospholipids, sphingomyelin, phosphatidylinositol, phosphatidylcholine, phosphatidylserine, phosphatidylethanolamine. Results . Prior to the start of chemotherapy, the changes in the ratio of main classes of phospholipids of mononuclear cell membranes in peripheral blood was documented in pulmonary tuberculosis patients versus those healthy. Chemotherapy resulted in the accumulation of membrane disruptive lysophospholipids with simultaneous reduction of phosphatidylcholine level. Treating patients with glycyrrhizic acid allowed diminishing (p < 0.05) the negative effect of chemotherapy on lipid membranes of mononuclear cells and improving the ratio of main fractions of membrane phospholipids (p < 0.05). When glycyrrhizic acid was added to the chemotherapy regimen, the sputum conversion rate by the 2nd month of the intensive phase increased from 61 to 73% (p < 0.05).

СПЕКТР И ФАКТОРЫ РИСКА НЕЖЕЛАТЕЛЬНЫХ ПОБОЧНЫХ РЕАКЦИЙ ПРИ ЛЕЧЕНИИ ВПЕРВЫЕ ВЫЯВЛЕННЫХ БОЛЬНЫХ ТУБЕРКУЛЕЗОМ

In order to evaluate the frequency and risk factors of adverse reactions, the monitoring results of clinical and laboratory tests of 435 new cases of respiratory tuberculosis being on the intensive phase of chemotherapy have been analyzed. 95.2% of patients had adverse reactions (95% CI 92.7-96.9); 48.7% demonstrated severe adverse reactions and in 72.7% treatment regimen had to be changed. Regarding the profile of adverse reactions, hepatotoxic ones prevailed (59.3%), they were followed by allergic reactions (53.6%), gastrointestinal reactions (35.6%) and hyperuricemia (61.6%). Certain risk factors have been identified for each of the above types of adverse reactions, making it possible to predict and prevent them prior to the start of chemotherapy.

Paradoxical Tuberculomas Complicating Tuberculous Meningitis: About Two Cases

AbstractParadoxical tuberculomas in patients with tuberculous meningitis during antituberculous chemotherapy is an unusual phenomenon. This reaction is due to the immune response of the host to antituberculous drugs. It is commonly seen in the intensive phase of chemotherapy. We report the cases of two patients with tuberculous meningitis who had developed tuberculomas during adequate and appropriate antitubercular therapy. Tuberculous meningitis requires the regular clinical and radiological follow-up to detect paradoxical response.

Determinants of Persistent Sputum Smear Positivity after Intensive Phase Chemotherapy among Patients with Tuberculosis at Rhodes Chest Clinic, Nairobi, Kenya

The prevalence of TB in sub-Sahara Africa has been reported as 511 per 100,000 populations and a mortality of 74 per 100,000 in year 2009. In the same period, incidence was estimated at 350 cases per 100,000. In this regard, the health system requires strengthening to respond to the rising cases of infection, drug resistance and quality of life lost while continuing to seek interventions that improve adherence to medication and case detection among those infected. Methods: This study sought to determine factors that are associated with sputum positivity after intensive phase of chemotherapy in people with tuberculosis. It was a retrospective case-control study conducted in Rhodes chest clinic, a City Council health unit in Nairobi that specializes in treatment of chest infections. The participants were sampled from clinic attendants who had completed two months of intensive phase TB chemotherapy and met inclusion criteria. Results: Seventy participants of whom 25 (36%) were sputum positive at the end of two (2) months intensive phase were included in the study. Skipping medication doses was significantly associated with sputum positivity (p = 0.01). Patients who were sputum positive at the end of the two-month period were more likely to have taken longer time before seeking treatment compared to those who were sputum negative by median (IQR) 8 (3 - 12) and 4 (3 - 8) weeks respectively although this difference was not significant (p = 0.09). Patients who had not disclosed their infection status had a two-fold possibility of remaining sputum positive at the end of intensive phase. Conclusion: Early diagnosis and treatment of TB, and adherence to medication were important factors that affect sputum conversion during intensive phase of TB treatment. Therefore, public health practitioners should advise patients to seek prompt diagnosis and treatment of signs and symptoms of tuberculosis.

Дія комплексної озоно- і лазеротерапії на прооксидантно-антиоксидантну рівновагу у крові хворих на туберкульоз легень в інтенсивній фазі хіміотерапії

The influence of complex of ozone- and lazerotherapy the level of endogenous intoxication, lipid peroxidation and activity of antioxidant enzymes in patients with destructive pulmonary tuberculosis in the intensive phase of chemotherapy was investigated. Analysis of the results of study conducted on the use of different modes of ozone- and laserotherapy found that an integrated treatment in combination with chemotherapy has a pronounced positive effect on the balance of prooxidant-antioxidant processes in patients with newly diagnosed pulmonary tuberculosis, compared with single chemotherapy. It was found that the greatest increase in activity of antioxidant enzymes and the level of inhibition of lipid peroxidation in erythrocyte membranes occurred in the conditions of exposure modes: with increasing ozone (step 2 mg/l) and decreasing ozone concentration of 2 to 12 mg/l ↑↓ number of procedures + internally laser irradiation of blood with frequency modulation 100 kHz and internal laser irradiation of blood with frequency modulation 100 kHz + ozone 2 to 12 mg/l ↑↓ (step 2 mg/l), under the background of chemotherapy (CT). Keywords: lipid peroxidation, antioxidant protection, molecule of middle mass, chemo-ozone-laserotherapy, tuberculosis.

Мембранозалежні процеси в еритроцитах крові хворих на туберкульоз легень за впливу гелій-неонового лазерного випромінювання

The effect of frequency modulated and unmodulated He-Ne laser irradiation of blood of patients with destructive pulmonary tuberculosis in the intensive phase of chemotherapy on the level of endogenous intoxication, the processes of lipid peroxidation and activity of antioxidant enzymes was investigated. Analysis of the results of study conducted after the application of intravenous laser irradiation of blood by helium-neon laser with different frequency modulations on the background of standardized chemotherapy demonstrated that the application of frequency modulation has a pronounced positive effect on the balance of prooxidant-antioxidant processes in patients with the first diagnosed pulmonary tuberculosis, compared to single chemotherapy and influence of modulated helium-neon laser irradiation of blood. The frequency-dependent stimulation of antioxidant system and the level of inhibition of lipid peroxidation in erythrocyte membranes under the influence of laser frequency modulation on a background of chemotherapy was detected. Marked intensification of compensatory processes, especially when using a helium-neon laser with frequency modulation 5 kHz and 100 kHz, was found. Keywords: erythrocytes, laser radiation, lipid peroxidation, antioxidant protection.

Paradoxical Tuberculomas after Completion of Antituberculous Treatment

Paradoxical reactions in tuberculosis have been reported in patients with tuberculous meningitis and appear as intracranial tuberculomas within 14–270 days of starting antituberculous therapy (ATT). Paradoxical reactions are due to the immune response of the host to ATT. They are commonly seen in the intensive phase of chemotherapy. However, paradoxical reactions occurring after completion of ATT are rare. We report 2 patients with tuberculous meningitis who had already completed ATT and then developed tuberculomas.

Refractory chronic immune thrombocytopenic purpura in a child with acute lymphoblastic leukemia

Immune thrombocytopenic purpura (ITP) has been associated with several hematologic malignancies such as Hodgkin and non-Hodgkin lymphomas and chronic lymphocytic leukemia, but it is rare in children with acute lymphoblastic leukemia (ALL). Here, we report a 7-year-old girl with chronic ITP during early intensive phase of chemotherapy for ALL. She underwent splenectomy because thrombocytopenia had persisted even after treatment with intravenous immunoglobulin (IVIG), steroids, vincristine, rituximab, and anti-D antibody. After splenectomy, her platelet count had recovered, and maintenance therapy could be resumed with a support of IVIG. To our knowledge, this is the first child case of chronic ITP during chemotherapy for ALL and splenectomy was effective in this patient.