Analysis of critical chemotherapy complications in children with acute leukemia and ways of their corrections

Abstract

Providing intensive care for critical conditions in pediatric hematological malignancies has its features and remains one of the most urgent tasks of pediatrics. Purpose - to assess the features of critical conditions in children with acute leukemia (AL) and to review the literature for their correction. Materials and methods. An analysis of the results of clinical, laboratory, and instrumental examination of 70 children treated in the Intensive Care Unit with AL aged from 1 month to 18 years has been carried out. Statistical analyses of data were conducted by STATISTICA 8. Results. Among the complications of cytostatic therapy, the following ones have been recorded: neutropenia (in 62 cases), agranulocytosis (16), hyperleukocytosis (1); critical thrombocytopenia (15) with the development of severe hemorrhagic syndrome (10) and hemorrhagic shock (2), disseminated intravascular coagulation syndrome (1); anemia of II-III degree (12), involvement of gastrointestinal tract in the form of stomatitis/esophagitis/gastroenterocolitis (16), hepatitis (21), pancreatitis (2), cardiopathy (2), cardiovascular failure (1), interstitional pneumonia (1), respiratory failure (6), acute renal failure (2), focal neurologic signs/seizures (2). Infectious complications included pneumonia (22), including one with acute lung destruction (5), pneumonia complicated by pleurisy (2) or pneumothorax (3), pyelonephritis (3), otitis media (3), contact peritonitis (2), meningitis (2), central vein phlebitis (4) with superior vena cava syndrome (2). The combination of pneumonia with other infectious foci was determined in 17 patients. Sepsis was diagnosed in 6 cases. Conclusions. In the examined patients there was a significant proportion of complications on the background of chemotherapy treatment of AL. The timely diagnosis and adequate correction of the complications can potentially reduce the mortality of AL. The research was conducted according to principles of Declaration of Helsinki. Protocol of research was proved by local ethical committee, mentioned in institution’s work. An informed consent was collected in order to carry out the research. No conflict of interests was declared by the authors.

Keywords

• intensive care
• complications
• chemotherapy
• acute leukemia
• children
• infections
• sepsis