Chemotherapeutic Complications in Adult Colombian Patients with Acute Lymphoblastic Leukemia in Hospital San Rafael: A Descriptive Study

2019 ◽  
Vol 1 (1) ◽  
pp. 35-42
Author(s):  
Carlos Alberto Castro Vásquez ◽  
Gabriel Alexander Quiñones Ossa ◽  
María Alejandra Pineda Castañeda ◽  
Diana Carolina Maldonado Gantiva ◽  
Julián Stiven Casas González ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Febrile Neutropenia ◽  
Hematological Malignancies ◽  
Lymphoblastic Leukemia ◽  
Infectious Complications ◽  
Induction Phase ◽  
Chemotherapeutic Regimen ◽  
San Rafael ◽  
Tract Infections ◽  
Clinical Records

Background. Acute Lymphoblastic Leukemia (ALL) is a hematolymphoid neoplasm with multiple complications and variable prognosis, which depends on several factors, one of them related to chemotherapeutic treatment. Objective. To describe the complications developed in patients diagnosed with ALL and who received chemotherapy treatment in Hospital San Rafael. Materials and methods. A retrospective analysis of clinical, paraclinical and demographic variables taken from clinical records of adult patients diagnosed with ALL admitted to hospital between 2016 and 2017. Results. A hundred and sixteen patients had hematological malignancies, 24 had ALL. Most of them had B-cell precursor ALL (79.2 %), 86.4 % were in the chemotherapy induction phase, 87.5 % developed febrile neutropenia, 37.5 % had tumor lysis syndrome, 58.3 % developed infectious complications, and 45.8 % died. Discussion. This is the first study known to date describing the complications in patients with ALL at Hospital San Rafael in Colombia. One of the major findings was the high frequency of febrile neutropenia episodes and infectious complications mainly associated with unfavorable outcomes, such as multiple organ failure and death. Therefore, clinicians should always have these complications in mind when a patient with hematological malignancies is receiving or is about to start a chemotherapeutic regimen. Conclusions. Bloodborne and respiratory tract infections were the most common sources of infection by Staphylococcus epidermidis and Klebsiella pneumoniae as causative agents. Likewise, the most frequent complication was febrile neutropenia. The first cause of death were infections complicated by sepsis; however, only one-third of the patients had a microbial isolation.

Downs Syndrome Patients with Acute Lymphoblastic Leukemia; an Intermediate Outcome with a High Infectious Morbidity.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4521-4521
Author(s):  
Mahasen Saleh ◽  
Ashraf R. Khairy ◽  
Hassan El-Solh ◽  
Mohammed Al-Mahr ◽  
Abdulrahman Al-Musa ◽  
...  
Keyword(s):  
Overall Survival ◽  
Acute Lymphoblastic Leukemia ◽  
Febrile Neutropenia ◽  
Fungal Infections ◽  
Lymphoblastic Leukemia ◽  
Chromosome 21 ◽  
Cell Phenotype ◽  
Induction Phase ◽  
Bleeding Tendency ◽  
Infectious Morbidity

Abstract Unlike AML, children with Down syndrome and Acute Lymphoblastic Leukemia (DS-ALL) have been reported to achieve significantly lower rates of remission, with higher mortality and a poorer overall survival. To further study this, we conducted a retrospective review for all DS children who were diagnosed and treated for ALL at our institution from 1997 to 2006. 12 (1.8%) out of 645 children (age 0–14 years) diagnosed with ALL had DS. The median age at diagnosis was 55 months (range 23 – 108 months) and eight were male. The most frequent signs and symptoms were fever (n=11; 91.6%), bleeding tendency (n=8; 75%) and organomegaly (n=9; 83.3%). The median WBC count at diagnosis was 4.99×109/L (range 0.58–500×109/L). The median platelet count and hemoglobin were 255×109/L and 80.5g/L, respectively. None of the patients had CNS disease at diagnosis. Leukemia cell cytogenetics revealed only the additional chromosome 21 for all patients, except in one patient who had 48XY,+X,+21. All cases had a precursor B-cell phenotype, and a DNA index of 1.0. Patients received treatment according to the protocol utilized for intermediate risk ALL at our institution. A good early response to induction therapy by a day-14 bone marrow (BM) evaluation was seen in all patients, and complete remission (CR) was achieved by day 28 of induction for the 11 who completed induction chemotherapy. One patient died toward the end of induction due to severe sepsis. Infection was the most commonly encountered morbidity throughout the course of therapy. Six episodes of febrile neutropenia, two documented bacteremias and one disseminated invasive Aspergillosis were reported during the induction phase. In the post-induction period, 21 episodes of febrile neutropenia were reported, in addition to six documented bacteremias and two patients developed fungal infections, one with fungemia and the other with a nail bed infection. Four patients relapsed at a median time of 13 months from diagnosis. Relapses occurred in the BM for two, as isolated CNS in one, and as combined BM and CNS relapse in one. Seven patients continue in first CR. The overall survival and the relapse free survival at 3 years were 53.7% and 60% respectively. Conclusion: Although DS ALL children do not present with poor-risk features (infancy, T-cell phenotype, adverse cytogenetics, CNS involvement) they tend to have an intermediate treatment outcome even if treated on relatively intensive protocols. Delays in appropriate therapy due to infectious morbidity could contribute to this sub-optimal outcome.

scholarly journals Impact of malnutrition on febrile neutropenia in children with acute lymphoblastic leukemia during induction phase chemotherapy

2018 ◽  
Vol 58 (6) ◽  
pp. 298-304
Author(s):  
Marshalla Agnes ◽  
Pudjo Hagung Widjajanto ◽  
Wahyu Damayanti
Keyword(s):  
Risk Factor ◽  
Acute Lymphoblastic Leukemia ◽  
Febrile Neutropenia ◽  
Lymphoblastic Leukemia ◽  
Inverse Correlation ◽  
Simple Random Sampling ◽  
Medical Emergency ◽  
Nutrition Status ◽  
Bivariate Analysis ◽  
Induction Phase

Background Acute lymphoblastic leukemia (ALL) is the most common malignancy in children and adolescents. Febrile Neutropenia (FN) is a medical emergency on ALL that often leads to death. Nutrition status assessment on ALL patient is important because malnutrition can reduce the tolerance of chemotherapy, increase incidence of infection and decrease survival rate. Objectives To assess malnutrition as a risk factor for FN in children with ALL. Methods This case-control study was performed at Sardjito Hospital, Yogyakarta on patients aged 1 month to 18 years diagnosed with ALL and undergoing induction phase chemotherapy between January 2013 and December 2015. The case and control subjects were children with and without FN, respectively. Febrile neutropenia was confirmed by patients temperature above 38ºC at one measurement and a peripheral neutrophil count of less than 1,000/mm3. Malnutrition was defined as body weight-for-height was between -2 and <-3 standard deviation. Subjects were included using simple random sampling. Result Bivariate analysis showed a significant correlation between malnutrition and FN (OR 2.62; 95%CI 1.07 to 6.45; P=0.03). However, there was no inverse correlation between socioeconomic status and FN (OR 1.1; 95%CI 0.42 to 2.41; P=0.83). There was no correlation between nutritional status and duration of FN (P= 0.48).   Conclusion Malnutrition is a risk factor for FN in children with acute lymphoblastic leukemia.

scholarly journals Retinal and Preretinal Hemorrhages in a Patient Receiving Hyper-CVAD Chemotherapy for T-Cell Acute Lymphoblastic Leukemia

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Krishi Peddada ◽  
Stephanie J. Weiss ◽  
Shaina Kumar ◽  
Deepika Malik
Keyword(s):  
Visual Acuity ◽  
Acute Lymphoblastic Leukemia ◽  
T Cell ◽  
Lymphoblastic Leukemia ◽  
Induction Phase ◽  
Severe Thrombocytopenia ◽  
Irreversible Damage ◽  
Chemotherapeutic Regimen ◽  
Cotton Wool Spots ◽  
The Right

Hyperfractionated cyclophosphamide, vincristine, adriamycin, and dexamethasone (Hyper-CVAD) is an important chemotherapeutic regimen for acute lymphoblastic leukemia (ALL) and non-Hodgkin’s lymphoma. We present a case of a 23-year-old male with T-cell ALL and visual acuity of 20/20 in the right eye and 20/25 in the left eye who developed significant changes in his vision after starting Hyper-CVAD therapy. The patient initially presented with cotton wool spots in the fundus shortly after starting the regimen. After going through the induction phase of chemotherapy, he had a sudden decline in his vision to light perception in the left eye. Posterior segment exam revealed retinal ischemia and multilayered hemorrhages in both eyes as well as a large preretinal hemorrhage obscuring the fovea in the left eye. Labs associated the appearance of these hemorrhages with a significant decrease in hemoglobin and a platelet count of 5 K/μL. A Nd:YAG laser applied in the left eye at the posterior hyaloid face allowed blood to drain into the vitreous cavity and brought the patient’s visual acuity back to baseline. Hyper-CVAD is an aggressive chemotherapy regimen that can cause severe thrombocytopenia secondary to myelosuppression. Frequent retinal evaluations and timely intervention is advisable in these cases as extensive intraretinal hemorrhages may cause irreversible damage.

Infectious complications in a child with acute lymphoblastic leukemia (case study)

Pediatru ro ◽  
2018 ◽  
Vol 4 (52) ◽  
pp. 47
Author(s):  
Mihaela Smărăndoiu ◽  
Ruxandra Vidlescu ◽  
Cristian Scurtu ◽  
Doiniţa Sfrijan
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Infectious Complications

scholarly journals Feasibility and Potential Benefits of an Exercise Intervention in a Male With Down Syndrome Undergoing High-Dose Chemotherapy for Acute Lymphoblastic Leukemia: A Case Report

2019 ◽  
Vol 18 ◽  
pp. 153473541983235
Author(s):  
Linda Bühl ◽  
Thomas Abel ◽  
Florian Wolf ◽  
Max Oberste ◽  
Wilhelm Bloch ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Acute Lymphoblastic Leukemia ◽  
Hematological Malignancies ◽  
Exercise Intervention ◽  
Lymphoblastic Leukemia ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Serious Adverse Events ◽  
Increased Risk ◽  
Potential Benefits

In patients with hematological malignancies, exercise is studied as a supportive measure with potential benefits on therapy and disease-related side effects. However, clinical trials have not yet integrated people with Down syndrome (DS), although this disability is associated with an increased risk for hematological malignancies. Therefore, we examined safety and feasibility of a mixed-modality exercise intervention in a male with DS undergoing high-dose chemotherapy for acute lymphoblastic leukemia. Furthermore, physical capacity and fatigue were assessed. Exercise sessions took place 3 times/wk over a 5-week period. Adherence to the exercise program was 100%, and no serious adverse events occurred. In contrast to the training sessions, applied endurance testing was not feasible. Furthermore, maintenance of fatigue level was observed. In conclusion, cancer patients with DS suffering from leukemia should not be excluded from physical activity or exercise programs.

Variants in vincristine pharmacodynamic genes involved in neurotoxicity at induction phase in the therapy of pediatric acute lymphoblastic leukemia

2019 ◽  
Vol 19 (6) ◽  
pp. 564-569 ◽  
Author(s):  
Idoia Martin-Guerrero ◽  
Angela Gutierrez-Camino ◽  
Aizpea Echebarria-Barona ◽  
Itziar Astigarraga ◽  
Nagore Garcia de Andoin ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Induction Phase ◽  
Pediatric Acute Lymphoblastic Leukemia

scholarly journals CAR-T Cell Therapy

2020 ◽  
Vol 21 (12) ◽  
pp. 4303
Author(s):  
Aamir Ahmad
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
T Cell ◽  
Cell Therapy ◽  
B Cell ◽  
Hematological Malignancies ◽  
Lymphoblastic Leukemia ◽  
T Cell Therapy ◽  
Car T Cell Therapy ◽  
Car T ◽  
Large B Cell

CAR-T therapy has revolutionized the treatment of select hematological malignancies, namely, acute lymphoblastic leukemia and large B-cell lymphomas [...]

Impact of anti‐oxidant status and apoptosis on the induction phase of chemotherapy in childhood acute lymphoblastic leukemia

Hematology ◽  
2011 ◽  
Vol 16 (1) ◽  
pp. 14-19 ◽  
Author(s):  
Youssef Al‐Tonbary ◽  
Samir Abou Al‐Hasan ◽  
Maysaa Zaki ◽  
Ayman Hammad ◽  
Shaimaa Kandil ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Childhood Acute Lymphoblastic Leukemia ◽  
Induction Phase ◽  
Anti Oxidant ◽  
Oxidant Status

Diagnostic accuracy of procalcitonin, interleukin-6 and interleukin-8 for predicting Gram-negative bacteremia in febrile neutropenia patients with acute lymphoblastic leukemia

2015 ◽  
Vol 21 (4) ◽  
pp. 178-181
Author(s):  
Vincas Urbonas ◽  
Audronė Eidukaitė
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Febrile Neutropenia ◽  
Diagnostic Accuracy ◽  
Interleukin 6 ◽  
Lymphoblastic Leukemia ◽  
Febrile Episode ◽  
Interleukin 8 ◽  
Serum Samples ◽  
Gram Negative ◽  
Gram Negative Bacteremia

Background. Currently available biomarkers are not specific and sensitive enough for early detection of bacterial infection in patients with cancer who have febrile neutropenia. The objective of this study was to assess diagnostic accuracy of interleukin-6 (IL-6), interleukin-8 (IL-8) and procalcitonin (PCT) in the identification of Gram-negative bacteremia at the beginning of a febrile episode in pediatric oncology patients with acute lymphoblastic leukemia (ALL). Methods. A total of 40 episodes of febrile neutropenia in 27 childhood cancer patients were enrolled in this study. Serum samples were collected at presentation after confirmation of febrile neutropenia and analyzed according to the recommendations of manufacturers. Patients were classified into Gram-negative bacteremia (GNB) and fever of unknown origin (FUO) groups. Results. The median concentration of IL-6, IL-8 and PCT were higher in the GNB group compared to the FUO group (65.4  vs.  409.0  pg/ml, P  =  0.0025; 166.0  vs.  883.0  pg/ml, P  =  0.0002; 0.27  vs.  0.44  ng/ml, P = 0.0169, respectively). The areas under the curves (AUCs) for both IL-6 and IL-8 were 0.94 and 0.93, respectively, indicating that these cytokines discriminated patients with Gram-negative bacteremia with excellent accuracy, whereas PCT had lower diagnostic accuracy (AUC = 0.76). Conclusions. IL-6 and IL-8 evaluation might be used as an additional diagnostic tool for the prediction of Gram-negative bacteremia in pediatric patients with ALL during febrile neutropenia episodes.

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