Serious adverse events associated with chemotherapy in children with acute lymphoblastic leukemia
XU Feng-Ling, GUAN Xian-Min, WEN Xian-Hao, SHEN Ya-Li, XIAO Jian-Wen, GUO Yu-Xia, DENG Meng-Yue, YU Jie
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
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.
XU Feng-Ling,GUAN Xian-Min,WEN Xian-Hao et al. Serious adverse events associated with chemotherapy in children with acute lymphoblastic leukemia[J]. CJCP, 2020, 22(8): 828-833.
XU Feng-Ling,GUAN Xian-Min,WEN Xian-Hao et al. Serious adverse events associated with chemotherapy in children with acute lymphoblastic leukemia[J]. CJCP, 2020, 22(8): 828-833.
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