HIGH INFECTION RELATED MORTALITY IN PAKISTANI CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKAEMIA DURING REMISSION INDUCTION CHEMOTHERAPY: REVIEW OF DATA FROM A SINGLE INSTITUTION

  • AUR Maaz Department of Paediatric Oncology Children’s Hospital for Wales Cardiff,
  • Farhana Badar Cancer Registry, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore,
  • Tariq Mahmood Pathology department, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
  • Ibrahim Al Nassir Paediatric Oncology, SKMCH&RC, Lahore

Abstract

Purpose: Despite advances in the treatment of acute lymphoblastic leukaemia (A.L.L.), the outcome for children living in the developing countries is still poor. This is in large part due to high treatment-related mortality (TRM). This study was carried out to review the data and analyze the factors resulting in high TRM during remission induction chemotherapy.

Methods: Data for children treated at our centre during the calendar year 2007 were retrospectively analysed. Standard four-drug induction chemotherapy was used without risk strati cation. Bone marrow evaluation was carried out at days 8 and 28. Cerebrospinal uid analysis was carried out on day 1 and with each subsequent intrathecal chemotherapy injection. Modern supportive care facilities including antibiotics, nutritional support and intensive care unit were available.

Results: Eighty-one children were eligible for analysis. Median age was 5 years (range 2–16), 72% were male with M:F ratio of 2.5:1. Seventy- five (92%) children had precursor B-cell A.L.L. Only 2 children had central nervous system leukaemia at presentation. Median presenting white blood cell count was 8.83 (range: 1–446). Severe malnutrition (weight <5th centile for age) was seen in 42% of children. Median symptom duration was 6 (range 1–30) weeks at the time of presentation. Induction mortality was 25%. Induction mortality was 25.6% (n = 21). Twenty were related to infections, while more than half (52%) occurred as a result of an outbreak of Acinetobacter infection. Severe malnutrition and Acinetobacter infection (due to an outbreak in our unit during the study period) were highly predictive of TRM during remission induction chemotherapy.

Conclusions: Infection control measures, health education and reduction in treatment intensity may improve survival for children with A.L.L. in Pakistani population.

Key words: Acute lymphoblastic leukaemia in children, malnutrition, Pakistan, treatment-related mortality

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Published
2016-12-31
How to Cite
1.
Maaz A, Badar F, Mahmood T, Al Nassir I. HIGH INFECTION RELATED MORTALITY IN PAKISTANI CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKAEMIA DURING REMISSION INDUCTION CHEMOTHERAPY: REVIEW OF DATA FROM A SINGLE INSTITUTION. J Cancer Allied Spec [Internet]. 2016Dec.31 [cited 2020Aug.15];2(4). Available from: https://journals.sfu.ca/jcas/index.php/jcas/article/view/94
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Original Research Article