Serious adverse events associated with chemotherapy in children with acute lymphoblastic leukemia.
- Author:
Feng-Ling XU
1
;
Xian-Min GUAN
;
Xian-Hao WEN
;
Ya-Li SHEN
;
Jian-Wen XIAO
;
Yu-Xia GUO
;
Meng-Yue DENG
;
Jie YU
Author Information
1. Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University/Chongqing Key Laboratory of Pediatrics/Ministry of Education Key Laboratory of Child Development and Disorders/National Clinical Research Center for Child Health and Disorders/China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China. 1808106657@qq.com.
- Publication Type:Journal Article
- MeSH:
Antineoplastic Agents;
adverse effects;
Child;
Gram-Negative Bacteria;
Humans;
Neutrophils;
Precursor Cell Lymphoblastic Leukemia-Lymphoma;
drug therapy;
Retrospective Studies;
Risk Factors
- From:
Chinese Journal of Contemporary Pediatrics
2020;22(8):828-833
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE:To study the occurrence of serious adverse events (SAEs) related to chemotherapy with CCCG-ALL-2015 regimen in children with acute lymphoblastic leukemia (ALL) and the risk factors for death after the SAEs.
METHODS:A retrospective analysis was performed on the medical data of 734 children with ALL. They were treated with CCCG-ALL-2015 regimen from January 2015 to June 2019. The occurrence of SAEs during the treatment was investigated. The children with SAEs were divided into a death group with 25 children and a survival group with 31 children. A multivariate logistic regression analysis was used to analyze the risk factors for death after the SAEs.
RESULTS:Among the 734 children with ALL, 56 (7.6%) experienced SAEs (66 cases) after chemotherapy, among which 41 cases occurred in the stage of remission induction therapy. Of all 66 cases of SAEs, 46 (70%) were infection-related SAEs, including 25 cases of septic shock (38%), 20 cases of severe pneumonia (30%), and 1 case of severe chickenpox (2%), and 87% of the children with infection-related SAEs had neutrophil deficiency. The most common infection sites were blood and the lungs. The most common pathogens were Gram-negative bacteria, viruses, fungi, and Gram-positive bacteria. There were 16 cases (24%) of hemorrhage-related SAEs, with 11 cases of gastrointestinal bleeding (17%), 4 cases of pulmonary bleeding (6%), and 1 case of intracranial bleeding (2%). Of all 734 children with ALL, 66 (9.0%) died, among whom 25 died due to SAEs. The treatment-related mortality rate was 3.4%, and infection (72%) and bleeding (24%) were the main causes of death. Severe pneumonia was an independent risk factor for treatment-related death in ALL children (OR=4.087, 95%CI: 1.161-14.384, P=0.028).
CONCLUSIONS:SAEs often occur in the stage of remission induction therapy, and infection-related SAEs are more common in ALL children accepting chemotherapy with CCCG-ALL-2015 regimen. The development of severe pneumonia suggests an increased risk for death in these children.
