Treatment-Related Mortality in Pediatric Acute-Lymphoblastic and Myeloid Leukemia: Experience from A Low- and Middle-Income Setting : Treatment-Related Mortality in Pediatric Acute-Lymphoblastic and Myeloid Leukemia

Sana Gull; Alia Ahmad; Luqman Iqbal; Rahat Ul Ain; Waqar Mushtaq; Mahwish Faizan

doi:10.54393/pjhs.v6i7.3125

Authors

Sana Gull Department of Pediatric Hematology Oncology, University of Child Health Sciences, The Children’s Hospital, Lahore, Pakistan
Alia Ahmad Department of Pediatric Hematology Oncology, University of Child Health Sciences, The Children’s Hospital, Lahore, Pakistan
Luqman Iqbal Department of Pediatric Hematology Oncology, University of Child Health Sciences, The Children’s Hospital, Lahore, Pakistan
Rahat Ul Ain Department of Pediatric Hematology Oncology, University of Child Health Sciences, The Children’s Hospital, Lahore, Pakistan
Waqar Mushtaq Department of Pediatric Hematology Oncology, University of Child Health Sciences, The Children’s Hospital, Lahore, Pakistan
Mahwish Faizan Department of Pediatric Hematology Oncology, University of Child Health Sciences, The Children’s Hospital, Lahore, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i7.3125

Keywords:

Acute leukemia, Children, Pediatric, Low-Middle Income Country, Treatment-Related Mortality, Sepsis

Abstract

Treatment-induced complications are challenging to manage in low-middle-income country (LMIC) settings, leading to higher mortality rates. Objectives: To ascertain the frequency, causes, and risk factors leading to treatment-related mortality (TRM) in children with acute leukemia (ALL and AML) in our setup. Methods: A Retrospective descriptive cohort study was done at the Hematology Oncology Department of the Children’s Hospital, Lahore. Using non-probability consecutive sampling, data of pediatric acute leukemia patients (<16 years of age) who experienced TRM during the study period were recorded. Results: Among TRM 136 (75%) had Acute-Lymphoblastic-Leukemia, and 45 (25%) had Acute-Myeloid-Leukemia. Median age of expiry 7.0 years (1–15years) with a Male-to-Female ratio 1.5:1. Underlying causes of TRM were Infection-related mortality in 168 (93%), Hemorrhage in 10 (5.5%), and Drug toxicity in 3 (1.5%). Under-nutrition (<10th centile) was found in 111 (61%) and 120 (67.4%) patients who were on active chemotherapy. Median hospital stays 10 days (1–45days) and median distance of residence to medical facility 222km (41–995km). Median values of hematological parameters at death: hemoglobin 8.0g/dl (2.6–14.7g/dl), WBC 0.57x103/mm3 (0.0-500), platelets 15x103/mm3 (0-503), and CRP 149mg/L(0.1–193mg/L). Significant factors associated were platelet counts (p=0.009), hemoglobin (p=0.001), and CRP (p=0.017). Conclusions: The Major cause of TRM in children with acute leukemia is infection. Noteworthy factors were male gender, residents of rural areas, cytopenia, high CRP, under-nutrition, and ongoing chemotherapy sessions. The majority of deaths occurred during Induction chemotherapy. Infection prevention/control and enhanced supportive care can result in decreasing TRM in acute leukemia.

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